Dr. Greg Vigna comments on a recent study that reveals a high number of patients reporting pain that may be caused by mesh arms outside the pelvis.
‘Some patients report pain that may be attributable to nerve impingement from mesh arms that are outside the pelvis (in the groin or in the ischiorectal fossa). In these cases, complaints should map to dermatomal distributions, and appropriate neurologic and radiologic evaluations should be carried out. Anecdotal evidence has described extensive extravaginal mesh excision, with or without nerve release procedures; there are some data suggesting that this may be more successful in cases of obturator neuralgia than of pudendal neuralgia’…AUGS 2020 Joint Position Statement
Dr. Greg Vigna, national pharmaceutical injury attorney, practicing physician, and Certified Life Care Planner states, “Clearly we have known for years of the latent injuries caused by polypropylene transvaginal mesh devices used for pelvic organ prolapse and stress urinary incontinence as symptoms may occur months to years following implantation of the device as it degrades, scars, and contracts under a perpetual inflammatory response related to the foreign body reaction. Recent articles by Fuentes that described latent injuries for retropubic and transobturator slings and now from a major study out of China involving 1855 patients supports this position. In this large Chinese study, the average onset of pain reported was 7.5 months with symptoms in one patient beginning 31 months post-implantation. The pain was reported in the vagina, perineum, buttocks, groin, lower abdomen, or multiple sites. Interestingly most had spontaneous pain in the buttocks, groin, and inner thigh that was aggravated by sitting or by certain movements such as walking, urination, or defecation.”
“Clearly, this recent study out of China is an important study as it relates to extrapelvic pain and latent injuries because the study involved a large number of women.” — Dr. Greg Vigna
Dr. Vigna states, “The mechanism of injury was described in the Journal of Urology in 2010 by Professor Rigaud from Nantes, France but AUGS and the manufacturers did nothing to protect women.”
‘In this series features of obturator neuralgia were observed in 10 cases, predominantly in the TOT group. In the majority of cases, surgical exploration revealed signs of compression of the obturator nerve in the obturator foramen due to hypertonia of the obturator internus muscle but with no direct nerve injury’…Professor Rigaud, Nantes, France
Dr. Vigna states, “Manufacturers have known for years that pelvic myofascial pain is caused by polypropylene mesh devices and have been aware of the mechanism of nerve irritation that causes extrapelvic pain that is often described as spontaneous pain in the buttocks, groin, and inner thigh that was aggravated by sitting or by certain movements such as walking as described by Dr. Shi, the author of the Chinese study. Clearly, in the case of TOTs it is clear that they produce a significantly increased risk of persistent myofascial pain compared to other pelvic surgeries. In fact, the Nantes Group in France wrote that they do not insert TOT slings in redo surgeries to avoid obturator nerve lesions or myofascial syndrome.”
Dr. Vigna adds, “We have known for years that polypropylene vaginal mesh devices cause ‘latent’ injuries, with symptoms occurring months to years after implantation as the polypropylene degrades, contracts, and scars with ongoing inflammation in the soft tissues next to key nerves that result in neuralgia and loss of function. To this day, manufacturers have never warned of this occurrence. Clearly, this recent study out of China is an important study as it relates to extrapelvic pain and latent injuries because the study involved a large number of women.”
Dr. Vigna is a California and Washington D.C. lawyer who focuses on catastrophic neurological injuries caused by transvaginal mesh devices including pudendal neuralgia, obturator neuralgia, ilioinguinal neuralgia, and Complex Regional Pain Syndrome. His cases are filed around the country with Martin Baughman, a Dallas Texas firm. Ben Martin and Laura Baughman are national pharmaceutical injury trial attorneys in Dallas, Texas who specialize in ‘one off’ catastrophic injuries caused by the IVF filter and vaginal mesh.
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 visit: https://vignalawgroup.com/ebooks/pelvic-mesh-pain/#page=59
Read a FREE EBOOK on Vaginal Mesh Pain: https://vignalawgroup.com/publications/
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For articles, video resources, and information visit the Pudendal Neuralgia Educational Portal or https://tvm.lifecare123.com/.
Visit our website for information regarding sling-related complications.
Greg Vigna, MD, JD
Vigna Law Group
1155 Coast Village Rd., Suite 3, Santa Barbara, CA
Cameron, Sabourin, et al. Pelvic floor hypertonicity in women with pelvic floor disorders: A case-control and risk prediction study. Neurourology and Urodynamiics. 2019; 38: 696-702.
Baron, Normand, Paret, Levesque, Rigaud, Perrouin-Verbe. Management of postoperative urinary incontinence after mid-urethral sling explantation for pelvic or perineal pain. 3 March 2021
Marcus-Braun, Bourret, von Theobald. Persistent pelvic pain following transvaginal mesh surgery a cause for mesh removal. European Journal of Obstetrics & Gynecology and Reproductive Biology. 5 March 2012.
Rigaud, Pothin, Labat, Riant, Gueriineau, Normand, Glemain, Robert, Bouchot. Functional Results After Tape Removal for Chronic Pelvic Pain Following Tension-Free Vaginal Tape or Transobturator Tape. The Journal of Urology2010.
Fuentes, Finsterbusch, Christie, P. Zimmern. Mesh Sling Arm Removal for Persistent Pain After An Initial Vaginal Suburethral Mesh Sling Removal Procedure. Female Pelvic Med Reconstr Surg 2021; 27: e522-e527
Shi, Zhao, Hu, GGgongg, Yin, Xia. Clinical analysis of pain after transvaginal mesh surgery in patients with pelvic organ prolapse.
Greg Vigna, MD, JD
Vigna Law Group
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