Neuropelveology also focuses on another aspect: the possibility to restore specific pelvic functions by electrostimulating the relevant nerves.
This approach is used to treat neurogenic vesical and intestinal dysfunction. Thus, nerve electrostimulation can be used to treat incontinence, hypercontinence (urinary retention), vesical sphincter dyssynergia and rectum sphincter dyssynergia (dysharmony in contractions). Dyssynergia is caused by insufficient interactions between the muscles needed for a given function. In paralyses caused by lesions of the spinal cord, important signals originating in the central nervous system are prevented from reaching the peripheral regions (the organs) even if the peripheral nerves in the pelvis are preserved and capable of stimulating the muscles they target, the intestines and the bladder. Functional electrostimulation (FES) of the small pelvis nerves may help restore function in such cases as well.
Different techniques can be used to implant electrodes on the target nerves, each technique having its own limitations:
- InterStimtherapy is a minimally invasive technique. The stimulation electrode is introduced from the outside through the buttocks and placed on a sacral root. Because the procedure is carried out in a blind manner (without any direct visual control of implantation), a multipolar electrode is used to ensure that stimulation occurs as close as possible to the targeted nerve. This method may be used to treat pain and functional vesical and intestinal disturbances. It does have one drawback, however: stimulation is limited to one single sacral root. InterStim therapy thus cannot be used when several sacral roots need to be stimulated.
- Medullary stimulation is another technique that introduces a multipolar electrode through the skin in the vicinity of the spinal cord. This method ensures that the electrical stimulation is oriented in the direction of pain signal transmission. However, it is non-specific: stimulation cannot target a particular nerve. Medullary stimulation is used to treat neuropathic pain, but it is ineffective for functional vesical and intestinal disturbances.
The LION procedure developed by Prof. Marc Possover can also be used to treat functional disturbances in a pelvic organ. In the case of the sacral plexus, the electrodes are implanted on the sacral roots using laparoscopy in order to restore vesical and intestinal function in both genders, but also erection and ejaculation capacity in men. In a 2006 world premiere, Prof. Possover successfully carried out a laparoscopic implantation of electrodes on a sacral root of a paraplegic woman. Ever since this operation, the patient has been able to empty her bladder and to defecate with the help of a remote control device. In another breakthrough procedure carried out by Prof. Possover back in 2003, electrodes were implanted for the first time in a paraplegic patient in order to restore balance and walking functions.
The LION procedure is carried out on sacral roots under general anaesthesia. This type of treatment of functional vesical and intestinal disturbances is thus more complex than the other subcutaneous implantation techniques. At the same time, the LION procedure offers the following advantages:
- The electrode is implanted under visual control.
- The electrodes and cables are optimally protected by the pelvic bone.
- Because there are virtually no movements deep inside the small pelvis, the electrodes generally remain in the right location.
- A single electrode can stimulate all the nerve roots together or separately on the side that is targeted. It is thus possible to treat a variety of different conditions, such as miction and defecation disturbances or complex pain syndromes (such as associated ischialgia, pudendal pain and other neuropathies).
- The LION procedure may be used successfully in cases where InterStim therapy fails. The converse is not true, however.