Comment explorer et traiter des douleurs postopératoires après chirurgie pelvienne ?

Pelvic-perineal surgery induces risks of chronic pain often unappreciated. Prosthetic surgery is a source of chronic pain, in particular prosthetic mesh for hernia or prolapse, sub-urethral slings for incontinence. The exploration is based essentially on the anamnesis, the clinical reports and the clinical examination. The occurrence of pain immediately or a few days after surgery is a key point in attributing pain to the surgical procedure. The characteristics of pain are essentially neuropathic and/or myofascial. Signs of central sensitization with more diffuse pain could be also present. The treatment is based primarily on surgical revision for ablation of the mesh with an improvement in 2/3 of cases. In case of failure, algological management with muscle relaxation in case of myofascial pain and/or specific medical management of neuropathic pain and pelvic sensitization could be proposed.