Polypropylene-induced fibrosis links to pudendal neuralgia; red flag symptoms and PVDF benefits emphasized

In our second clinical case, an irritation of the nerve might have occurred due to the fibrosis generated by the posteriorly deviated passage of the sling in the obturator foramen, close to the sacrospinous ligament” … Dr. Nasser Habib, Gynecologist, Siena, Italy.

What else did Dr. Habib report in “Pudendal Neuralgia: Two case reports with laparoscopic nerve decompression” published in Facts Views Vision Obgyn, 2023 June; (12(2): 181-187.

“The arm of the TOT sling pierced the obturator muscle posteriorly causing severe local fibrosis and retraction of the sacrospinous ligament at the level of the ischial spine. The arm of the TOT sling was cut at the level of the obturator foramen, followed by a section of the sacrospinous ligament at the level of the ischial spine, allowing the complete release of the pudendal nerve.”

“Inexplicably, mid-urethral slings made of polyvinylidene fluoride (PVDF) are still not available in the United States despite being available across the world.” — Greg Vigna, MD, JD

How did Dr. Habib’s patient do?

“The patient reported 50% improvement of her symptoms immediately after surgery and was managed with pelvic floor physiotherapy and oral gabapentin for 3 months. The improvement was stable at 3 and 6 months after the surgery. Continuation of the pelvic floor physiotherapy was suggested but medical therapy was stopped. Her anogenital pain was reported as 2/10 and the dyspareunia as 4/10 using VAS score. No urinary incontinence was reported.”

To read Dr. Habib’s article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10410660/

Dr. Greg Vigna, national product liability attorney states, “Dr. Habib’s description of the severe local fibrosis caused by polypropylene was responsible for an indirect nerve injury to the pudendal nerve. His patient suffers from pudendal neuralgia. Inexplicably, mid-urethral slings made of polyvinylidene fluoride (PVDF) are still not available in the United States despite being available across the world. PVDF triggers less inflammation and fibrosis after implantation when compared with polypropylene. Dr. Sabadell, in 2020, showed that transobturator slings made of PVDF caused less obturator pain and less dyspareunia when compared with polypropylene transobturator slings at one year.”

To learn more about Dr. Sabadell’s article: https://onlinelibrary.wiley.com/doi/full/10.1002/nau.24586

Dr. Vigna RED FLAP WARNING SYMPTOMS of neurological injury or myofascial pain syndromes including Complex Regional Pain Syndrome from mid-urethral slings include:

1) Groin pain
2) Hip pain
3) Inability to wear tight pants
4) Clitoral pain or numbness
5) Severe pain that makes vaginal penetration impossible
6) Tailbone pain
7) Anorectal pain
8) Painful bladder
9) Pain with sitting

Click here for a FREE BOOK on Vaginal Mesh Pain: https://vignalawgroup.com/publications/

Dr. Vigna is a California and Washington DC lawyer who focuses on catastrophic injuries and the neurological injuries caused by mid-urethral slings including pudendal neuralgia, obturator neuralgia, ilioinguinal neuralgia, and complex regional pain syndrome. Ben Martin is a national pharmaceutical injury attorney in Dallas, Texas. The lawyers represent women in courts across the country.

Greg Vigna, MD, JD
Vigna Law Group
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