Neuropathic pain with vesical and rectal hyperreflexia and cocontraction after pelvic surgery

Pelvic and pudendal nerve injury can occur during extirpative visceral surgery such as radical hysterectomy.1 2 Many of these patients develop severe chronic pelvic pain and bladder symptoms, and are often referred to neurologists with suspicion of lumbosacral plexus lesions or disc disease. There are few or no signs on examination, and patients are often considered to be “hysterical”, despite having severe symptoms. Here, we describe two patients in whom severe pelvic pain and bladder dysfunction developed after hysterectomy, and who demonstrated detrusor and rectal hyperreflexia with cocontractions, features usually associated with lesions of the CNS. Whereas spinal cord sensitisation is well recognised after somatic nerve injury, our studies provide the first clear evidence for its development after visceral nerve injury in humans, and a method for its detection using ambulatory urorectodynamics.

Patient 1, a 42 …