Pelvic nerve damage secondary to surgery for pelvic organ prolapse – risk procedures, symptoms

Introduction All pelvic, perineal and obstetrical procedures potentially expose patients to pelvic nerve injuries. Damages happening during interventions (Primary Nerve Injury – PNI) are due to coagulation, suturing, ischemia or cutting and induce troubles of sensation, pain and dysfunctions starting immediately after the procedure or after a short interval of several days. In contrast, nerve lesions by fibrotic tissue or vascular compression/entrapment (Secondary Nerve Entrapment – SNE) usually require several months or even years to develop. Implantation of sutures or mesh material or hematoma/abscess formation in proximity to nerves constitute a risky situation for both PNI and/or SNE. Transvaginal sacrospinous colpopexy is the classical high risk procedure for pudendal nerve injury by direct lesion while suturing the sacrospinous ligament [1] but also by entrapment when a hematoma or an abscess of the ischiorectal space develops. More recent interventions using mesh material for sacrospinal fixation [2], sacro-colpopexy or rectopexy may also expose patients to risk of nerve damage. However, reports about iatrogenic pudendal neuralgia are rare in current literature [3]. We thus believe that the rates of iatrogenic pelvic nerve damage secondary to pelvic organ prolapse surgery are unknown and probably widely underestimated. The purpose of this manuscript is to report about our experience with nerve injuries secondary to pelvic organ prolapse surgeries.