Vaginal infiltration for relief of neuropathic pain after sacrospinous hysteropexy: First successful mid-term report

Reporte de caso

Published on 15 de enero de 2025 | http://doi.org/10.5867/medwave.2025.01.2958

Vaginal infiltration for relief of neuropathic pain after sacrospinous hysteropexy: First successful mid-term report

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Timeline of clinical findings and procedures.

Day	Description
Day 0	The patient was referred for evaluation at the Pelvic Floor Unit due to genital prolapse. POP-Q genital prolapse anterior stage 3 (Ba +2), posterior stage 2 (Bp 0) and apical stage 1 (C -3), negative stress urinary incontinence.
Day 1	Evaluated by the pelvic floor clinical committee, cystometry is requested.
Day 50	Cystometry: no leakage on Valsalva. Leakage with empty bladder: negative, postvoid residual: 0 ccs, 1st voiding desire: >300 ccs, urgency: no, maximum cystometric capacity: >300 ccs. Detrusor instability: no. No pain is reported.
Day 56	A transvaginal ultrasound was performed with normal results.
Day 126	Evaluation by the surgical committee. Options are discussed. Due to a lower surgical risk and a quick recovery, it is decided to perform anterior repair plus sacrospinous hysteropexy.
Day 136	Genital prolapse surgery was performed, anterior repair plus sacrospinous hysteropexy with Anchosure® kit, without incidents.
Day 137	Postoperative evolution within expected parameters. Discharge from the hospital is decided.
Day 145	First postoperative control. The patient reports pain VAS 8/10. Oral analgesia is prescribed.
Day 175	Pain persists despite oral analgesia. A physiotherapy evaluation is requested. Pregabalin is added to the prescription.
Day 191	The patient begins physical muscle relaxation therapy. Five sessions are performed, and therapies are suspended due to pain. Discomfort persists during defecation.
Day 210	A slight reduction of pain after starting pregabalin. Defecatory MRI is requested, reporting rectocele and cystocele.
Day 224	A new muscular evaluation by a physiotherapist was performed. Hyperactivity was present in the bulbocavernosus, right pubovesical, puborectalis, iliococcygeus, and left coccyx muscles. Pain persists, VAS 9/10.
Day 230	Due to refractoriness to treatment, it was decided to infiltrate the painful points identified in the physical examination and toward the left suture area with Anchosure®.
Day 231	Outpatient follow-up and infiltration of sore spots with bupivacaine and betamethasone were performed. Minutes after the procedure, the patient reported pain relief, VAS 1/10.
Day 245	Post-infiltration control, the patient remains asymptomatic. VAS 1/10.
Day 425	Follow-up shows a VAS score of 1/10. No gluteal or anal pain was reported. Discharge is decided.

Ba, most prolapsed portion of the anterior vaginal wall. Bp, most prolapsed portion of the posterior vaginal wall. C, leading edge of the cervix or vagina. MRI, magnetic resonance imaging. POP-Q, quantification of pelvic organ prolapse.VAS, visual analog scale.

Notes: Findings and procedures are ordered chronologically until patient discharge.

Source: Prepared by the authors.