TVT-O and the Obtryx sling cause pudendal neuralgia and the mechanism is acute injury to the obturator internus muscle during implantation of the device.
In 2005 Dr. Noor M. Gajraj was the first physician to report in the literature the successful use of Botox injection into the obturator internus muscle in a woman suffering from pudendal neuralgia who unfortunately experienced only partial relief of her pain after pudendal nerve release surgery in France and had exhausted every known treatment available for her pudendal nerve entrapment. Dr. Gajraj smartly understood the anatomy of the pudendal canal, also referred to as Alcock’s canal, that it is formed by the obturator internus muscle and its fascia which is in close association with the pudendal nerve as the nerve passes into the pelvis from the spine. He believed that muscle spasms could cause compression or traction to the adjacent pudendal nerve that could account for her ongoing pain despite pudendal nerve decompression. To reduce the suspected muscle spasm, he injected 100 units of Botox, a potent muscle relaxer, into the obturator internus muscle via fluoroscopic guidance and the result was impressive: 3 months of 90% pain relief which correlates to the duration of action of Botox.
“Targeted Botox injections have been improving the quality of life for my clients with pudendal neuralgia caused by TOTs.” — Dr. Greg Vigna
Dr. Greg Vigna, national pharmaceutical injury attorney, practicing physician, and Certified Life Care Planner comments, “Ethicon and Boston Scientific have known for years that the TVT-O and the Obtryx sling, both of which are transobturator (TOT) slings, cause pudendal neuralgia and the mechanism is acute injury to the obturator internus muscle during implantation of the device which will cause acute shortening or spasm of the injured muscle. They also have known for years that polypropylene is not inert and degrades overtime in the obturator internus muscle which leads to perpetual scarification and mesh shrinkage that may cause traction or compression injury to the pudendal nerve.”
Botox has been used for over two decades in the treatment of dystonia and cerebral spasticity from strokes, brain injury, and cerebral palsy. Dystonia is the sustained involuntary muscle contraction that leads to abnormal posture. Spasticity is the velocity dependent increase in muscle tone that interferes with voluntary movement.
Dr. Vigna concludes, “Targeted Botox injections have been improving the quality of life for my clients with pudendal neuralgia caused by TOTs. Now we are seeing women with symptoms of pudendal neuralgia undergoing Botox into the obturator internus muscle at the time of mesh removal and at the time of pudendal nerve decompression in attempts to relax the muscle during the healing process to reduce traction or compression on the pudendal nerve at Alcock’s canal. Testifying experts are including Botox in the life care plans of our catastrophic clients as it is medically necessary.”
The Vigna Law Group targets the following transvaginal mesh (TVM) devices known to injure the obturator internus muscle and cause obturator and pudendal neuralgia:
- Ethicon: TVT-O, Abbrevo
- Boston Scientific: Obtryx, Solyx
- Coloplast: Aris, Altis
Dr. Vigna is a California and Washington DC lawyer who focuses on catastrophic neurological injuries caused by transvaginal mesh devices—injuries including pudendal neuralgia, obturator neuralgia, ilioinguinal neuralgia, and Complex Regional Pain Syndrome. He has clients with these diagnoses filed around the country with Martin Baughman, a Dallas Texas firm representing many of those clients. Ben Martin and Laura Baughman are national pharmaceutical injury trial attorneys in Dallas.
To learn more on the anatomical basis for TOT injury or irritation to the obturator and pudendal nerve and the treatments of obturator and pudendal neuralgia click here.
Click here for a FREE BOOK on Vaginal Mesh Pain. For articles, video resources, and information visit the Pudendal Neuralgia Educational Portal: https://pudendalportal.lifecare123.com/ or https://tvm.lifecare123.com/ and read our book for information regarding sling related complications.