Nonsurgical management Evaluation and treatment can be very challenging in this patient population. Exam and imaging to exclude occult recurrence is important. Following that, use of antiinflammatories, nerve blocks, neuromodulators, and<unk>  clinic referrals should be considered. Unless there is evidence of a recurrence, operative intervention should be deferred for at least 1 year since groin<unk>  decreases with time elapsed from surgery. Triple neurectomy and/or mesh removal If operative repair is chosen, mesh excision +/- triple neurectomy may be considered with small studies suggesting good outcomes. The largest series encompassing 415 patient, most following open or suture repair, demonstrates significant improvement following triple neurectomy. However, standard triple neurectomy does not address inguinodynia secondary to neuropathy of the genitofemoral nerve and the preperitoneal segment of its genital branch. But extension of the standard triple neurectomy to include the genitofemoral nerve has given good results, on a small series of 16 patients. Mesh removal should only be considered in last resort. Meshes are easy to place but difficult to remove, due to their incorporation inside the peritoneum. Other algorithms proposed have included diagnostic laparoscopy at the start for evaluation of adhesions, removal of mesh, and repair of any recurrences. If there is no improvement then a staged procedure to remove mesh and neurectomy may be considered.
Post herniorraphy pain syndrome
Post-vasectomy pain syndrome
Descending perineum syndrome
Urologic chronic pelvic pain syndrome
Urethral syndrome
Pelvic congestion syndrome
PELVIS syndrome
Rectovaginal fistula