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Laparoscopic implantation of electrodes for bilateral neuromodulation of the pudendal nerves and S3 nerve roots for treating pelvic pain and voiding dysfunction

Abstract

Introduction and Hypothesis

The objective of this video is to describe the technique for laparoscopic implantation of electrodes for bilateral neuromodulation of S3 and pudendal nerves. We report a successful case of a 48-year-old woman with spina bifida occulta referred with a 14-year history of intense acyclic pelvic pain, urinary hesitancy, and intermittent flow refractory to various conservative measures.

Methods

The procedure began with the removal of two previously placed InterStims. A quadripolar electrode was then laparoscopically inserted into Alcock’s canal and attached to the pelvic pectineal line. Another lead was placed juxtaneurally to S3. Lead contacts were then exteriorized, and the peritoneum closed. The same procedure was then performed on the contralateral side. The leads were connected to a 16-pole rechargeable pulse generator. Postoperatively, the patient developed an acute dissection and partial thrombosis of the external iliac artery, which was treated endovascularly.

Results

Complete pain resolution was observed with simultaneous S3 and pudendal stimulation, with pudendal stimulation turned off for voiding.

Conclusions

We conclude that laparoscopic implantation of neuromodulation electrodes allows simultaneous stimulation of S3 and pudendal nerves, providing more programming options and possibly increasing success rates in complex pelvic floor dysfunction cases.

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Fig. 1

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Acknowledgements

The original version of this video was awarded the prize for best video in pelvic pain during the 2015 AAGL Global Congress (15–19 November 2015, Las Vegas, NV, USA) and submitted to the IUJ for publication. The current version is improved with suggestions of IUJ reviewers. The patient signed an informed consent before each procedure performed and authorized the use of all images and data for scientific purposes. The consent form was revised and approved by the Committee for Ethics in Human Research of the Federal University of São Paulo.

Author information

Correspondence to Nucelio Lemos.

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Disclosures

Nucelio Lemos received research grants from Medtronic Inc. and Laborie Inc. and proctorship grants from Medtronic Inc. and Johnson & Johnson. None of these grants are directly related to the current publication. None of the coauthors have anything to disclose.

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Consent

Written informed consent was obtained from the patient for publication of this video article and any accompanying images.

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Li, A.L.K., Marques, R., Oliveira, A. et al. Laparoscopic implantation of electrodes for bilateral neuromodulation of the pudendal nerves and S3 nerve roots for treating pelvic pain and voiding dysfunction. Int Urogynecol J 29, 1061–1064 (2018). https://doi.org/10.1007/s00192-017-3411-7

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Keywords

  • Chronic pelvic pain
  • Neuromodulation
  • Pudendal
  • LION procedure
  • Laparoscopy