Abstract:

Bladder dysfunctions have been treated for decades through medical treatments or surgical procedures, especially in the context of prolapse conditions and stress incontinence. Over the last decade, sacral nerve modulation (SNM) has been introduced as a further option in the treatment of some urinary and fecal symptoms. Current techniques of percutaneous implantation are limited to superficial extrapelvic nerves that expose patients to lead migration and dislocation or infections, complications that cannot be ignored. Access to endopelvic nerves and plexuses will be mandatory in the future, especially to the sacral plexus area that is the crossroads of all vesical-sphincteric, anorectal, and sexual functions. The endopelvic location of electrodes protects against the above mentioned complications. Some open-surgical approaches have been described in the past, but all of them were extremely laborious and dangerous. All these limitations were overcome with the introduction of laparoscopy into the field of pelvic oncology. Laparoscopic retroperitoneal surgery and the development of video-endoscopy and appropriate instruments allows for access and visibility to all pelvic nerves and plexuses as well as laparoscopic pelvic neurosurgical procedures. One of these methods is the implantation of neuroprothesis—a technique called the “LION procedure”—which permits selective electrical stimulation of pelvic nerves and plexuses. One very interesting site of implantation for treatment of urinary and faecal symptoms is the pudendal nerve (PN). Stimulation of this nerve induces two different actions: a strong contraction of the sphincters—treatment of urinary and faecal incontinence and an inhibitory effect on the bladder—and treatment for bladder overactivity.

Authors:

Marc Possover, MD, PhD, Possover International Medical Center, Zuerich, Switzerland, Professor of Neuropelveology, University of Aarhus, Aarhus, Denmark

PMID:  24700226

For Direct IP Access please click this link