LION procedure / spinal cord injury / MESH complications
Neuropelveology includes the diagnosis of pelvic nerve injury, disease and dysfunction, as well as treatment of its associated symptoms and secondary conditions. The pelvic nerves play an important role in movement and feeling in the legs, control and release of urine and stool and control of sexual function.
The Pyramid Clinic is home to the world’s first Centre of Excellence in Neuropelveology – a medical discipline developed by Professor Possover based on the discovery of the pelvic nerves and their specific functions for the entire pelvic area and its organs. Neuropelveology includes the following diseases and treatments:
You can find further information on these diseases and their treatment options on Professor Possover’s website: https://www.possover.com/en/
For people who have gone through a variety of therapies without success, neuropelveology may represent a solution that can lead to significant improvement in their quality of life. This is particularly worth pursuing if the actual cause of the symptoms or disease is found in the pelvic nerves.
In order to be able to perform pelvic nerve interventions as effectively and gently as possible, nerve-sparing pelvic surgery techniques have been developed using laparoscopy and laparoscopic implantation of neuroprosthetics, which enable genital nerve stimulation (GNS therapy). Electrostimulation of the nerves enables patients to regain control of bladder, bowel and sexual functions. The neuropelveological view also opens up new pathways in the treatment of neuropathic pelvic pain, pelvic nerve endometriosis and pelvic nerve dysfunction. Neuropelveology also represents a quantum leap in the treatment of patients with spinal cord injury. In the LION procedure (Laparoscopic Implantation Of Neuroprothesis) the nerves are stimulated, thereby activating certain functions.
In patients with spinal cord injury, electrodes and a rechargeable pacemaker, which is similar to a cardiac pacemaker, are laparoscopically implanted in the body. The pacemaker uses electrical cables (electrodes) to supply electrical current to the pelvic nerves for muscle movement. By stimulating the nerves that stimulate the gluteal muscles in the buttocks, the pelvis is stabilised. In addition, stimulation of the nerves that control the muscles in the thighs causes extension of the knee joints and thus leg extension. The patient can then perform individual steps by rotating the trunk and then stretching the knee. Patients can control the individual parameters and stimulation programs themselves via a remote control. While direct muscle stimulation triggers jerky movements, nerve stimulation that acts indirectly on the muscles leads to harmonious movements, is gentler on the tendons and joints and prevents premature muscle fatigue. This type of movement requires sufficient strength in the forearms to stabilise the upper body. Since the introduction of this new technology, researchers have discovered that nerve stimulation also has the potential to promote nerve growth and reconnection of nerve fibres.
Mesh implants or tapes are used in certain gynaecological procedures. If complications occur, the pelvic nerves can be damaged, which can lead to loss of feeling, numbness, burning pain or dysfunction. If a pelvic nerve injury is diagnosed, a thorough clinical evaluation and further clarification of the diagnosis are indispensable. First, it must be determined exactly which nerve has been injured. Laparoscopic exploration may be considered in the next treatment step. Here, the area is precisely examined with the help of a very small camera. This allows for accurate diagnosis of the cause. In this same treatment step, decompression of the affected nerves is achieved by releasing the nerves. The aim of the procedure is not to remove the mesh, but to completely release the nerve. Another treatment option is the implantation of neuromodulation electrodes for nerve injuries in which the nerves are irreversibly damaged.