Groin Pain After a Tension-Free Vaginal Tape or Similar Suburethral Sling: Management Strategies
Duckett JR, Jain S.
BJU Int.2005;95:95–97.
More and more sling procedures are being performed by more and more urologists and urogynecologists. It is inevitable that we will encounter more sling-specific complications. Pain is certainly one of the most worrisome postoperative complications after any pelvic operation. What is a surgeon to do if a woman complains of groin pain after a sling procedure?
Duckett and Jain, gynecologists from Kent, United Kingdom, reviewed different treatment strategies for women with groin pain after tension-free vaginal tape (TVT) or similar suburethral sling procedures. The investigators reviewed a series of 450 women who had a TVT procedure, with a follow-up of 3 to 50 months. Of these 450 women, 5 (1%) reported significant groin pain and were offered further treatment. In addition, one woman was referred from another center and received treatment.
In most women, pain resolved after initial conservative treatment and required no further treatment. When discomfort was persistent or severe (4 women), it was treated with a combined steroid and local anesthetic injection. Treatment caused no adverse effects. One woman was relieved of her pain and required no further treatment. Local injections did not improve symptoms in 1 woman, but the pain was not severe enough to warrant further treatment.
Pain recurred after initial success with injection in 2 women; in these 2 women the TVT was excised. In addition, the woman referred from another center was primarily treated with TVT excision. In these 3 women, the mean pain score was 8.7 before distal tape excision and decreased to 0.7 afterward. One woman was awaiting tape excision at the time the investigators wrote their report.
On the basis of their experience, Duckett and Jain concluded that if conservative management fails to relieve the symptoms of groin pain, the pain can be treated by injection of a mixture of steroid and local anesthetic. Local injection, however, failed to provide long-term relief in 3 of 4 women. More severe symptoms might require TVT mesh dissection and excision, which can provide significant pain relief.