Surgical management of pudendal nerve entrapment after sacrospinous ligament fixation

Objective: To analyse the efficacy of sacrospinous ligament (SSL) suture removal on the reduction of pain symptoms in the case of suspected pudendal nerve entrapment after sacrospinous ligament fixation (SSLF).

Design: Retrospective cohort study.

Setting: Tertiary referral centre, the Netherlands.

Population: A cohort of 21 women having their SSLF sutures removed because of SSLF-related pain symptoms.

Methods: Clinical record review.

Main outcome measures: The primary outcome was reduction of pain after SSL suture removal. Secondary outcome measures were time interval between suture placement and suture removal, complete suture removal, adverse events and recurrence of pelvic organ prolapse (POP).

Results: A total of 21 women underwent SSL suture removal for severe and/or persistent pain, which was confirmed on clinical examination: 95% of the women (20/21) reported pain reduction after suture removal, and 57% reported complete pain relief. The time interval between suture placement and suture removal was at a median of 414 days (range 8-1855 days). Sutures could be completely removed in 86% of cases (18/21). One woman had excessive blood loss (520 ml) without blood transfusion. At 6-8 weeks after surgery, 10% of the women (2/21) had renewed symptomatic POP, stage ≥ 2, for which additional POP surgery was indicated.

Conclusions: When performed by an experienced clinician, SSL suture removal is feasible and efficacious, with low morbidity. In addition, the risk of recurrent POP in the short term appeared to be low.

Tweetable abstract: The surgical removal of sacrospinous ligament sutures is safe and efficacious for pain relief, even remote from initial placement.