Pudendal neuralgia (PN) is associated with the use of a trans-obturator placement of pelvic mesh, that is a treatment for stress urinary incontinence (SUI) that involves the use of a polypropylene surgical mesh (or ribbon or sling or hammock, all describe a SUI mesh) to support the urethra.
Running the mesh through the obturator space presents additional challenges to movement and additional potential for pain and damage.
The TVT-O (tension free vaginal tape obturator, has been found to be defectively designed in several product liability trials, yet it remains on the market.
Image: Dr. Michael Hibner
Chronic Pelvic Pain Treatment Protocol
Pudendal neuralgia pain may result in a burning sensation or dyspareunia, pelvic pain with sitting, discomfort with tight clothing, problems with the bladder and/or bowel, genital or anal pain.
According to Dr. Hibner, a urogynecologist based in Arizona, when a patient comes in she is first subject to an MRI imaging. On the same day, she receives a physical therapy assessment, all part of diagnosis and initial treatment.
Then if the are pelvic floor muscle spasms, she is scheduled for Botox injections then vaginal suppositories. She will receive Botox injections and wait 2 weeks for it to be effective. If the patient has pain relief after Botox, it’s a pelvic floor muscle spasm as opposed to pudendal neuralgia.
If there is no relief of pain after Botox, the patient is offered three CT Guided Nerve Blocks. The goal is to diagnose pudendal neuralgia and deliver steroid to relieve pain. If a patient receives four, five or six months of pain relief, he will not offer that patient surgery but tell them to return every six months.
Next they proceed with surgical removal of all of the mesh including the arms vaginally and abdominally. He uses a robot in the abdomen to find the arms. If part of the mesh is removed and the arms only remain,removal is much more difficult. Surgery could take six to ten hours which includes a Burch procedure, an anti-incontinence surgery.
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