The two main nerve complications TOT-injured women report in support groups are 1) pudendal and 2) obturator in that order. Because most studies do not evaluate for nerve injuries past 3-12 months, there is no scientific estimate of how common the injury is. Our experience is that it is extremely common. Pudendal injury causes persistent pain localized around the urethra and around the clitoris, irradiating to the one labia majora (maximum at the lower edge of symphysis) or both.
Polypropylene creates cripples when placed inside the pelvis.
The pudendal nerve is nowhere near the pathway of an obturator tape so how did the women get injured? The mystery may have been solved by three Czech investigators.
In 2011, Jaromir Masata & Petr Hubka & Alois Martan decided to look into why their patient, a 48 years old female obtained a pudendal nerve injury. After receiving a TVT-O, the woman experienced what the authors saw as an “atypical” postoperative pain that continued without relief for three years. While the authors treated her with injections and replaced her sling with yet another dubious tape, the work they did to track down the cause of her injury is valuable.
Authors circled scar and placed a “+” pointing to correct placement location.
The woman’s insertion scar (see Figure 1) was in the wrong place. By using a cadaver to trace the aberrant passage of her sling, the researchers found it intersected with the pudendal nerve. How many others were injured this way? Are you one of them? Was your transobturator tape placed incorrectly? If the manufacturer provided short videos and an instruction sheet, was that adequate training for your surgeon?
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When talking to women who are suffering the consequences after pelvic mesh implant surgery, the obturator nerve is one of the most common injuries they describe because transobturator tapes (slings) cause mesh trouble. Your obturator nerve begins at your psoas major muscle, travels through your obturator foramen (an opening in the pelvic bone) and then enters your thigh, where it divides into two branches, anterior and posterior.
Signs & Symptoms
• Pain localized to medial thigh radiating to groin or knee
• Pain exacerbated with activity
• Adductor weakness
• Paresthesia over medial aspect of distal thigh
• Loss of adductor tendon reflex with preservation of other lower extremity reflexes
• Positive EMG (electromyogram) and nerve conduction tests.
Damage to this nerve can be felt as pain, numbness your skin on the inside of your thighs and weakness of your thighs. This injury can affect the workings of you hip and knee joints and your abductor muscles and gracilis muscle which move the thighs when they close.
Your obturator nerve can be damaged through injury to your nerve itself, but also when the surrounding tissue is injured, causing swelling and inflammation which constricts blood flow inside the nerve itself.
Treatment: Mild damage to your obturator nerve can be treated with physical therapy, including stretching, deep tissue massage, and ultrasound. Medication for pain and anti-inflammatory drugs may help. More severe cases may require surgery to release the anterior division through the obturator canal.
We will explore each of the nerve injuries on our list in upcoming blog posts at meshtroubles.com
If you’d like to join an online support group and learn about erosion, partial removals, surgeons, or just find out that you are not alone, check the list of support groups here.
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This blog contains first-hand opinions about pelvic surgical mesh from a calliope of experience: from 8 years of meetings, phone calls, emails and social network with mesh victims, interviews with surgeons, years of front-line emergency nurse work and early work in biostatistics and medical research, to walking the mesh walk today. I’ve learned about the magnificent inner strength of women facing unparalleled and unimaginable pelvic injuries and, along with it physical, emotional, social and spiritual challenges that would buckle the knees of the bravest soldier. These women inspire me in their tenacity and unwillingness to let go of the true joy in their lives.
To those women, I dedicate this blog.