This presentation is a brief introduction of an exciting new pelvic surgical disciple based on detailed understanding of pelvic nerve anatomy and function, established by Prof Marc Possover, founder of the International Society of Neuropelveology. The society’s website, www.theison.org has wealth of resources including E-Learning Course “Clinical Neuropelveology” which will have lectures and videos (Available from March 2016) with Certification at the end of completion of online examination.

This new field of pelvic surgery has wide ranging implications to gynaecological surgery. The detailed knowledge and understand of pelvic nerves, particularly the pelvic autonomic nervous system, not only allows us to refine our surgery to be more respectful to the neural structures, it fundamentally changes our approach to the a “nerve sparing approach”, this is particularly so in more radical surgery such as in case of extensive deeply infiltrative endometriosis. It’s akin to nerve sparing radical hysterectomy approach where the autonomic pelvic nerve are identified and dissected free of harms way prior to excision. In situation where injuries has occur to pelvic nerve one can better understand and diagnose as well potential treat such complications. Neuropelveology has uncovered uncommon and less well-understood pathologies that involves pelvic nerves including endometriosis in pelvic nerves and vascular entrapments syndromes where with better understanding of pelvic neuroanatomy one becomes better prepared for such conditions. 

Perhaps the even more exciting aspect of Neuropelveology lies in the expanded therapeutic roles with the use of implanted stimulating electrodes for the treatment of patients with chronic pelvic pain syndromes, patients with pelvic organ dysfunctions (bladder over-activities, faecal urgency and certain sexual dysfunction) as well as patients with spinal cord injury (SCI) to aid ambulation. In patients with pelvic pain syndromes and pelvic organ dysfunctions, implanted electrode induces electro-modulation similar to the better know Sacral Nerve Stimulation. In patients with SCI, implanted electrodes over major pelvic nerves (Femoral and Sciatic) leads to extension of knees and hips to aid weigh bearing and ambulation.

The presentation will briefly highlight some of the practical aspects of this exciting new field of pelvic surgery, which will no doubt continue to evolve and refine in its wide ranging applications.