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Bladder Slings: Mechanism of Groin Pain Defined and Supported by AUGS

Dr. Greg Vigna

Dr. Greg Vigna

The AUGS 2020 Joint Position Statement on the Management of Mesh-Related Complications finally recognizes the neurological pain caused by midurethral slings.

Finally, AUGS in this position statement has formally recognized the pain syndromes that have destroy the lives of women for over two decades. ”
— Dr. Greg Vigna

SANTA BARBARA, CA, UNITED STATES, June 4, 2021 / -- ‘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, “The AUGS 2020 Joint Position Statement on the Management of Mesh-Related Complications for the FPMRS Specialist published by AUGS and the International Urogynecological Association has finally recognized the neurological pain caused by midurethral slings and the mechanism of injury. The article states that ‘extrapelvic pain’ is caused by nerve entrapment from the arms of retropubic and transobturator (TOT) slings.”

Dr. Vigna states, “Finally, AUGS in this position statement has formally recognized the pain syndromes that have destroy the lives of women for over two decades. The mechanism of injury was described in the Journal of Urology in 2010 by Professor Rigaud from Nantes, France but AUGS 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.

Dr. Vigna states, “Manufacturers have known for years that pelvic myofascial pain is caused by polypropylene mesh devices. In the case of TOTs it is clear that they produce a significant increased risk of persistent myofascial pain compared to other pelvic surgeries. In fact, Professor Rigaud in a recent 2021 article stated that his group doesn’t insert TOT slings in redo surgeries to avoid obturator nerve lesions or myofascial syndrome.”

Dr. Vigna adds, “We have known for years that retropubic and TOTs cause ‘latent’ injuries, with symptoms occurring at times years after implantation as the polypropylene degrades, contracts, and scars with ongoing inflammation next to key nerves that result in neuralgia and loss of function. Latent injuries are now conclusively supported in the literature and occur in up to a third of women with ongoing pain. Manufacturers have known about the magnitude of the harm for years and failed to design safer devices that either take the polypropylene away from the key nerves of the pelvis or stop using the inexpensive polypropylene and move to other polymers that are associated with less inflammation and degradation.”

Dr. Vigna concludes, “The physician experts in Nantes, France recommend complete mesh removal for TOT related obturator neuralgia and retropubic sling removal with aid of laproscopy. Very few physicians in the United States offer this level of care. Even more scarce are those who have the skill, knowledge, experience, and training to diagnose obturator, pudendal, and ilioinguinal neuralgia and treat these maladies post-complete mesh removal.”

Dr. Vigna is a California and Washington DC 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.

Click here 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. Read our FREE BOOK on Vaginal Mesh Pain or listen to a Podcast from the Vigna Law Group:

For articles, video resources, and information visit the Pudendal Neuralgia Educational Portal and read information regarding sling related complications by following this link:


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 post-operative urinary incontinence after midurethral sling explantation for pelvic orr 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

Greg Vigna, MD, JD
Vigna Law Group
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