Pain after suburethral sling insertion for urinary stress incontinence

Introduction and hypothesis Pain after suburethral sling insertion is an uncommon, but troublesome complication of continence surgery; in some cases it can cause significant distress and disability. It is often not recognised, poorly diagnosed and treated by gynaecologists and urologists unfamiliar with the condition. Methods A literature review was performed and the current evidence on pain after suburethral sling insertion reviewed. Results The tension-free vaginal tape–obturator (TVT-O) procedure is associated with an increased incidence of early groin pain, but this often resolves with expectant management. Chronic pain may be difficult to treat. The injection of local anaesthetic and steroid solutions may provide relief in some patients. Cognitive behavioural therapy has a place in treatment. In resistant cases, surgical excision may be needed. Retropubic slings can be removed laparoscopically or by open exploration of the Cave of Retzius. Obturator tapes may require groin exploration. Conclusions Sling removal may result in recurrent incontinence and further tissue and nerve damage. It does not always cure pain and may exacerbate the problem.