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Case Reports
. 2016 Sep 23:9:727-730.
doi: 10.2147/JPR.S106150. eCollection 2016.

Dorsal clitoral nerve injury following transobturator midurethral sling

Chailee F Moss  1 , Lynn A Damitz  2 , Richard H Gracely  3 , Alice C Mintz  3 , Denniz A Zolnoun  4 , A Lee Dellon  5
Affiliations
Case Reports

Dorsal clitoral nerve injury following transobturator midurethral sling

Chailee F Moss et al. J Pain Res. .

Abstract

Introduction: Transobturator slings can be successfully used to treat stress urinary incontinence and improve quality of life through a minimally invasive vaginal approach. Persistent postoperative pain can occur and pose diagnostic and therapeutic dilemmas. Following a sling procedure, a patient complained of pinching clitoral and perineal pain. Her symptoms of localized clitoral pinching and pain became generalized over the ensuing years, eventually encompassing the entire left vulvovaginal region.

Aim: The aim of this study was to highlight the clinical utility of conventional pain management techniques used for the evaluation and management of patients with postoperative pain following pelvic surgery.

Methods: We described a prototypical patient with persistent pain in and around the clitoral region complicating the clinical course of an otherwise successful sling procedure. We specifically discussed the utility of bedside sensory assessment techniques and selective nerve blocks in the evaluation and management of this prototypical patient.

Results: Neurosensory assessments and a selective nerve block enabled us to trace the source of the patient's pain to nerve entrapment along the dorsal nerve of the clitoris. We then utilized a nerve stimulator-guided hydrodissection technique to release the scar contracture.

Conclusion: This case demonstrates that the dorsal nerve of the clitoris is vulnerable to injury directly and/or indirectly. Assimilation of a time-honored pain management construct for the evaluation and management of patients' pain may improve outcomes while obviating the need for invasive surgery.

Keywords: clitoral pain; complication; nerve entrapment; postoperative pain.

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Figures

Figure 1
Figure 1
Pudendal branches, mapped by clinical exam and neurostimulation. Notes: (A) Dorsal nerve of the clitoris (continuation of pudendal nerve shown as dashed line deeper in the muscles of the urogenital diaphragm); (B) perineal branch of the pudendal nerve; (C) pudendal nerve; (D) superficial transverse perineal muscle; (E) ischiocavernosus muscle; (F) inferior pubic ramus; (G) block location. The course of the specified nerves is delineated based on quantitative sensory testing and selective nerve blocks in this patient. The arrow delineates the site of needle entry for the selective block for the perineal branch of the pudendal nerve.
See this image and copyright information in PMC

References

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