1) I've had a set of symptoms I've complained about since my hysterectomy and transobturator tape surgery 9 years ago. My new neurologist that treats my Complex Regional Pain Syndrome practices at the Vincera Institute which specializes in core injuries. The neurologist was concerned that I might have structural damage in my pelvis from the original surgery that needed to be repaired. After seeing a surgeon and a specialize MRI that focuses on the pubic bone I was diagnosed with athletica publagia also referred to as sports hernia.
The doctor believes when the transobturator bladder sling was placed some of the adductor muscles of my legs and rectus abdominus muscles that attach to the pubic bone were torn off the pubic bone. Because of these tears I've had uneven loading on the pubic bone which has caused chronic changes to my pubic bone. I have a lot of scarring from both the sling placement and surgeries to remove the sling which is causing constrictions of my adductor muscles. When I saw Dr. Dellon about 5 years ago he thought I had some tears of the adductor muscles and showed my mother and I that the lumps in my legs he thought were muscles that had been torn off the pubic bone. This surgeon said pretty much the same thing as Dr. Dellon. I choose not to have surgery with Dr. Dellon because in consultation with Dr. Howard we felt all the surgery that Dr. Dellon was recommending could cause more harm than good. At this point, the surgeon and I both agree that I have managed to compensate to walk,the surgeon wasn't sure that after all these years that he could pull the muscles back onto to the pubic bone to attach, concerns that because I have other pathology in my pelvis (right obturator internus muscle atrophy and pelvic floor dysfunction) that I probably couldn't do the PT to make the surgery a success that I am not going to have surgery to reattach the muscles to the pubic bone. We are going to try some obturator nerve blocks then send me to PT and see if PT can break up some of the scar tissues and do active release therapy on my adductor muscles. I can't tolerate my adductors being touched and I my adductor muscles spasms anytime PT or my massage therapist try to work on them so we are hopeful that if the signal to my brain is blocked using a nerve block my legs won't hyper-react to treatment by spasming.
The moral of the story, if you are one of the women on the forum who had a transobturator tape bladder sling and are still having groin pain, difficulty taking a full length step, difficulty with resistance walking (for example, water walking), difficulty with a full stretch of the inside of the legs this might be a diagnosis to consider. The surgeon told me right after he saw me he had another woman patient that had the same type of bladder sling and woke up from her surgery in such severe pain they immediately removed the sling. He said her adductor muscles were totally torn off her pubic bone by the sling placement.
2) Another finding on my MRI was a pudendal neuroma at the ischial spine on the right side. Explains the continued complaints I've had since my pudendal surgery that I still can't sit and that it was very painful to put pressure on the right sit bone. Now I know why. This was probably caused by my pudendal surgery. The interventional radiologist at the Vincera Institute has injected the pudendal neuroma twice. Not sure what the plan will be to deal with the neuroma. Not excited about any surgery but may have to see if they can remove this.
Therefore, another moral of my story, if you continue to have problems sitting after your pudendal surgery a pudendal neuroma might be a possibility. Even though the pudendal neuroma was on my pelvic MRI I had in December the radiologist missed it on their read
. It was only because I needed the special MRI of the pubic bone that the 2nd radiologist saw the pudendal neuroma. I asked them if it was on the MRI in December and they did relook at the MRI for me and it was there. 3) Another finding on my MRI was severe obturator internus muscle atrophy on the right side. I know just enough about how to read MRIs that I saw this myself and when it wasn't on my MRI report I made multiple calls and finally spoke with the attending radiologist. The MRI was updated to reflect this finding. The doctors are quite sure it is a deinnervation atrophy, in other words, the nerve to the muscle was damaged and can no longer make the muscle contract so basically the muscle dies. There is no way to know what caused the damage to the nerve. Options include when the bladder sling was placed, when the bladder sling was removed, or when I had my pudendal surgery. My gyn is absolutely convinced it was when the bladder sling was placed. This finding explains what was seen on my pelvic floor biofeedback traces.
Overall, don't trust if your MRI says it is normal. I had several findings that were missed on both MRIs I had, I've only mentioned two of the missed findings. Also, there can be physical causes that explain your pain, sometimes it just takes a long time to figure them out.
