Genitofemoral and Perineal Neuralgia After Transobturator Midurethral Sling

• Published in: Obstetrics and gynecology (New York. 1953) Vol. 119; no. 2; pp. 428 - 431
• Main Authors: Parnell, Brent A., Johnson, Elisabeth A., Zolnoun, Denniz A.
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD The American College of Obstetricians and Gynecologists 01-02-2012; Lippincott Williams & Wilkins
• Subjects: Amides; Analgesics, Non-Narcotic - therapeutic use; Anesthetics, Local; Autonomic Nerve Block; Biological and medical sciences; Carbamazepine - therapeutic use; Cranial nerves. Spinal roots. Peripheral nerves. Autonomic nervous system. Gustation. Olfaction; Female; Gynecology. Andrology. Obstetrics; Humans; Lidocaine; Lower Extremity - innervation; Lower Extremity - physiopathology; Medical sciences; Middle Aged; Nervous system (semeiology, syndromes); Neuralgia - diagnosis; Neuralgia - drug therapy; Neuralgia - etiology; Neurology; Pain, Postoperative - diagnosis; Pain, Postoperative - drug therapy; Pain, Postoperative - etiology; Perineum - innervation; Perineum - physiopathology; Ropivacaine; Suburethral Slings - adverse effects; Vulva - innervation; Vulva - physiopathology; Nervous system diseases; Pain; Neuralgia; Neurological disorder; Obstetrics; Gynecology
• ISSN: 0029-7844; 1873-233X
• DOI: 10.1097/AOG.0b013e31822c96cb

Midurethral slings successfully treat stress urinary incontinence through a minimally invasive vaginal approach. Postoperative pain related to sling placement can occur and poses both diagnostic and treatment dilemmas.
Four years after transobturator midurethral sling placement, the patient presented with complaints of left labial pain and dyspareunia since surgery. Using sensory mapping and a nerve stimulator, the problem was identified in the distribution of the genitofemoral nerve. Conservative therapy with a centrally acting neuromodulatory drug and nerve block relieved the pain.
Postsling neuralgia diagnosis using sensory mapping and a nerve stimulator aids in indentifying the nerve involved and in successful conservative treatment with a nerve block.