Neuropelveology - The discovery of the pelvic nerves
The pelvis is not only the anatomical site of various organs such as the bladder, the rectum, and the reproductive organs, but also contains the pelvic nerves. No other part of the body except the brain and spinal cord contains as many and such important nerves. Pelvic nerves are involved in the control of sexual functions, the collection and elimination of urine and feces, and movement and sensation in the legs. Damage to these nerves can therefore lead to functional disorders all mentioned organs and functions.
In general, the number of patients suffering from pelvic nerve disorders is grossly underestimated.
A neuropelveologist have to deal with the diagnosis and treatments of all pelvic organs damages and dysfunctions, not just overactive bladder, fecal and urinary incontinence or incapacity for urination, but also:
- Pelvic neuropathic pain conditions (genital pain, inguinal pain, pudendal pain, back and sciatic pain…
- Sexual dysfunctions in women and men
- Loss of functions in spinal cord injured peoples
- Pelvic bone and pelvic nerves tumors (teratoma, schwannoma, oestochoondrosarcoma…)
Laparoscopy allows sparing of pelvic nerves during pelvic surgeries
High-resolution video cameras for laparoscopes have been developed that provide magnification and allow for the introduction of microsurgical instruments. Thanks to these developments, all pelvic nerves are now easily accessible by laparoscopy. Nerve-sparing pelvic surgeries are designed to maintain the functions of the bladder, bowel and sexual organs after pelvic surgical procedures .
A new treatment option for many patients affected by intractable pelvic nerve pain
Neurosurgical procedures for the treatment of peripheral nerves pathologies (nerves outside the brain and spinal cord) can now be performed laparoscopically: nerve decompression (relief of pressure), neurolysis (release of a nerve sheath), and nerve reconstruction are safe and effective procedures to treat pelvic neuropathic pain. The laparoscopic approach offers at same time the diagnoses and treatments for causes for pelvic neuropathic pain conditions.
Univ.-Prof. Dr. med. Marc Possover
President of the International Society Of Neuropelveology
The LION procedure has revolutionized the treatment of overactive bladder, incontinence and troubles of sexuality
Neuromodulation – the application of safe electricity to the nerves – is also suitable for the treatment of patients with pelvic nerve dysfunctions. The method, known as the LION procedure – Laparoscopic Implantation Of Neuroprothesis, allows the surgeon to place an electrode directly on the affected pelvic nerves. The LION procedure is the first technique that enable the selective placement of electrodes on selected pelvic nerves for targeted electrical stimulation of these nerves.
The LION procedure to the “pudendal nerve” is indicated to control overactive bladder and urinary and fecal incontinence – especially the combination of both.
Because the genital nerve regulates both sexual excitation and erection of the clitoris and of the penis, the GNS – Genital Nerve Stimulation – improves drastically sexual satisfaction in both sexes.
The LION procedure has revolutionized the treatment of spinal cord injured peoples
In spinal cord injured peoples, electrodes and a rechargeable pacemaker are inserted in the body by laparoscopy. The pacemaker supplies the electrical current needed for the electrodes to ensure optimal muscle movements. The nerves that innervate the gluteal muscles (buttocks) are stimulated in order to stabilize the pelvis, and those that control the femoral (thigh) muscles are stimulated to trigger extension of the knee and thus leg extension. Individual steps are achieved by shifting the trunk forward followed by knee extension. The entire process of locomotion is activated and ended by a remote control unit. This allows the patients to freely decide where to “walk” and fully concentrate on maintaining balance without worrying about operating the remote control.
Direct muscle stimulation produces jerky, spasmodic movements because it produces “all or nothing” muscle contractions. Nerve stimulation, on the other hand, results in harmonious movement, is gentler on the tendons and joints, and prevents rapid muscle fatigue. This type of locomotion requires sufficient lower arm strength to stabilize the upper body.
Since the introduction of this new technology, researchers have found that nerve stimulation offers the potential to support nerve growth and, thus, the reconnection of nerve fibers.