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Mesh complications

Injuries to the pelvic nerves resulting from surgery

Marc Possover,
Mai 21, 2022

Challenging diagnosis, difficult access and lack of an interdisciplinary approach.

Although three different disciplines converge in dealing with the pelvic nerves - visceral surgery, urology and gynecology - and neurologists and neurosurgeons have specialized in the treatment of nerve damage to the brain and spinal cord, diagnosis and therapy of the pelvic nerves have so far hardly advanced at all. While most peripheral nerves are relatively superficial and easily accessible during surgery, the pelvic nerves lie deep, ventral to the sacrum, hidden behind the rectum and iliac vessels. This makes them virtually inaccessible for neurological examinations and surgical procedures. The pathology of the pelvic nerves, especially the somatic pelvic nerves, is still a sector virtually unknown in medicine. "Pelvic specialists" deal with diseases of the pelvic organs and not the pelvic nerves; while neurologists and neurosurgeons are concerned with the nerves in general, they do not deal directly with those of the pelvis.

In addition, nerve injuries after operations, such as mesh implantations, are usually not recognized as such.

The women and men affected in these situations are left trying to cope alone with their fate and suffering. They become stuck in a permanent spiral of physician´s visits and are treated in numerous ways; psychotherapeutically, with an array of painkillers, analgesics and antidepressants, but usually without a resulting treatment plan that can tackle the problem at cause.

Neuropelveology: a new approach in the diagnosis and treatment of the pelvic nerves

Neuropelveology closes this gap as a new, integrated discipline. It deals with the diagnosis and treatment of the pelvic nerves and plexuses. To diagnose the pathology of the pelvic nerves, neuropelveology uses diverse expertise from different specialties in their established approaches.

Neuropelveology enables many affected women with severe nerve pain of unexplained origin to receive therapy that not only treats pain symptoms, but also the disease itself. The neuropelveological approach paves the way for the diagnosis of the true root cause of the pain.

Since neuropelveology is a young medical discipline, relatively few gynecologists, surgeons and urologists, general practitioners and pain therapists around the world are currently focusing on this approach. As a result, endometriosis of the sciatic nerve (e.g.) too often goes undetected. Unfortunately, this deprives those affected of the chance of a curative treatment. However, this is about to change as the International Society of Neuropelveology was founded in 2014, due to the increasing interest in this new discipline. The Society is now represented globally and offers certified training in Neuropelveology.

The diagnosis of pelvic nerve diseases in 5 steps

Certified neuropelveologists are familiar with the diseases of the pelvic nerves and have undergone systematic training in the surgery of these pelvic nerves (certified neuropelveologist ISoN-Level 3). On the basis of the symptoms, a physician trained in this way can make a diagnosis easily and without great effort. The more symptoms and malfunctions that are present, the simpler and safer the diagnosis. It is important to be aware that the pain is felt at the very end of the nerves, i.e. at the pelvic organs or at the nerve endings of the lower nervous plexus in the back or pelvis, all the way down to the foot, while the cause can be found somewhere on the nerve pathways to the brain.

Neuropelveological diagnosis includes:

  1. The precise questioning of the patient regarding the disease history, as well as
  2. A careful physical palpation examination
  3. Ultrasound examination of the pelvic nerves using the vaginal or rectal route. The possible cause is also determined via
  4. The medical history or by means of a neuro-MRI.
  5. Finally, laparoscopy is used for the final determination and confirmation of the cause and at the same time, for the treatment of the nerve disease.

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Marc Possover