Intrapelvic Nerve Entrapments

  • Nucelio L. B. M. LemosEmail author


It is long known that a large portion of the lumbosacral plexus is located intra-abdominally, in the retroperitoneal space (Gray, Anatomy of the human body. IX. Neurology. 6d. The Lumbosacral Plexus, 1918). However, most of literature descriptions of lesions on this plexus refer to its extra-abdominal parts, whereas its intra-abdominal portions are often neglected (Possover et al., Fertil Steril 95(2):756–8, 2011).

The objective of this chapter is to describe the laparoscopic anatomy of intrapelvic nerve bundles, as well as the findings and advances already achieved by Neuropelveology practitioners.


Sciatic Nerve entrapment Gluteal pain Neuromodulation Laparoscopy 



Nucelio Lemos received research grants from Medtronic Inc. and Laborie Inc. and travel and proctorship grants from Medtronic Inc. None of these grants are, however, directly related to the current publication.


  1. 1.
    Gray H. Anatomy of the human body. IX. Neurology. 6d. The lumbosacral plexus. London: Bounty; 1918.Google Scholar
  2. 2.
    Possover M, Schneider T, Henle KP. Laparoscopic therapy for endometriosis and vascular entrapment of sacral plexus. Fertil Steril. 2011;95(2):756–8.CrossRefPubMedGoogle Scholar
  3. 3.
    Possover M, Chiantera V, Baekelandt J. Anatomy of the sacral roots and the pelvic splanchnic nerves in women using the LANN technique. Surg Laparosc Endosc Percutan Tech. 2007;17(6):508–10.CrossRefPubMedGoogle Scholar
  4. 4.
    Possover M. Use of the LION procedure on the sensitive branches of the lumbar plexus for the treatment of intractable postherniorrhaphy neuropathic inguinodynia. Hernia. 2013;17(3):333–7. Scholar
  5. 5.
    Grigorescu BA, Lazarou G, Olson TR, Downie SA, Powers K, Greston WM, Mikhail MS. Innervation of the levator ani muscles: description of the nerve branches to the pubococcygeus, iliococcygeus, and puborectalis muscles. Int Urogynecol J Pelvic Floor Dysfunct. 2008;19(1):107–16.CrossRefPubMedGoogle Scholar
  6. 6.
    Barber MD, Bremer RE, Thor KB, Dolber PC, Kuehl TJ, Coates KW. Innervation of the female levator ani muscles. Am J Obstet Gynecol. 2002;187(1):64–71.CrossRefPubMedGoogle Scholar
  7. 7.
    Wallner C, van Wissen J, Maas CP, Dabhoiwala NF, DeRuiter MC, Lamers WH. The contribution of the levator ani nerve and the pudendal nerve to the innervation of the levator ani muscles; a study in human fetuses. Eur Urol. 2008;54(5):1136–42.CrossRefPubMedGoogle Scholar
  8. 8.
    DeGroat WC, Yoshimura N. Anatomy and physiology of the lower urinary tract. In: Handbook of clinical neurology 3rd series. Oxford: Elsevier; 2015.Google Scholar
  9. 9.
    Bouche P. Compression and entrapment neuropathies. Handb Clin Neurol. 2013;115:311–66. Scholar
  10. 10.
    van der Jagt PK, Dik P, Froeling M, Kwee TC, Nievelstein RA, ten Haken B, Leemans A. Architectural configuration and microstructural properties of the sacral plexus: a diffusion tensor MRI and fiber tractography study. Neuroimage. 2012;62(3):1792–9. Scholar
  11. 11.
    Denton RO, Sherrill JD. Sciatic syndrome due to endometriosis of sciatic nerve. South Med J. 1955;48(10):1027–31.CrossRefPubMedGoogle Scholar
  12. 12.
    Lemos N, Kamergorodsky G, Ploger C, Castro R, Schor E, Girão M. Sacral nerve infiltrative endometriosis presenting as perimenstrual right-sided sciatica and bladder atonia: case report and description of surgical technique. J Minim Invasive Gynecol. 2012;19(3):396–400. Scholar
  13. 13.
    Lemos N, D’Amico N, Marques R, Kamergorodsky G, Schor E, Girão MJ. Recognition and treatment of endometriosis involving the sacral nerve roots. Int Urogynecol J. 2016;27(1):147–50.CrossRefPubMedGoogle Scholar
  14. 14.
    Missmer SA, Bove GM. A pilot study of the prevalence of leg pain among women with endometriosis. J Bodyw Mov Ther. 2011;15(3):304–8. Scholar
  15. 15.
    Pacchiarotti A, Milazzo GN, Biasiotta A, Truini A, Antonini G, Frati P, Gentile V, Caserta D, Moscarini M. Pain in the upper anterior-lateral part of the thigh in women affected by endometriosis: study of sensitive neuropathy. Fertil Steril. 2013;100(1):122–6. Scholar
  16. 16.
    Amarenco G, Lanoe Y, Perrigot M, Goudal H. A new canal syndrome: compression of the pudendal nerve in Alcock’s canal or perinal paralysis of cyclists. Presse Med. 1987;16(8):399.PubMedGoogle Scholar
  17. 17.
    Possover M, Lemos N. Risks, symptoms, and management of pelvic nerve damage secondary to surgery for pelvic organ prolapse: a report of 95 cases. Int Urogynecol J. 2011;22(12):1485–90. Scholar
  18. 18.
    Ganeshan A, Upponi S, Hon LQ, Uthappa MC, Warakaulle DR, Uberoi R. Chronic pelvic pain due to pelvic congestion syndrome: the role of diagnostic and interventional radiology. Cardiovasc Intervent Radiol. 2007;30(6):1105–11.CrossRefPubMedGoogle Scholar
  19. 19.
    Lemos N, Marques RM, Kamergorodsky G, Ploger C, Schor E, Girão M. Vascular entrapment of the sciatic plexus causing catamenial sciatica and urinary symptoms. In: 44th annual meeting of the International Continence Society (ICS), 2014, Rio de Janeiro. Neurourology and urodynamics, vol. 33. Hoboken: Wiley; 2014. p. 999–1000. Scholar
  20. 20.
    Possover M. Laparoscopic management of endopelvic etiologies of pudendal pain in 134 consecutive patients. J Urol. 2009;181(4):1732–6. Scholar
  21. 21.
    Possover M. The sacral LION procedure for recovery of bladder/rectum/sexual functions in paraplegic patients after explantation of a previous Finetech-Brindley controller. J Minim Invasive Gynecol. 2009;16(1):98–101.CrossRefPubMedGoogle Scholar
  22. 22.
    Rempel D, Dahlin L, Lundborg G. Pathophysiology of nerve compression syndromes: response of peripheral nerves to loading. J Bone Joint Surg Am. 1999;81(11):1600–10.CrossRefPubMedGoogle Scholar
  23. 23.
    Lemos N, et al. Intrapelvic nerve entrapments: a neglected cause of perineal pain and urinary symptoms. In: “Scientific Programme, 45th Annual Meeting of the International Continence Society (ICS), 6–9 October 2015, Montreal, Canada.” Neurourology urodynamics, vol. 34(Suppl 3); 2015. p. S53–5. Scholar
  24. 24.
    Possover M, Schurch B, Henle K. New strategies of pelvic nerves stimulation for recovery of pelvic visceral functions and locomotion in paraplegics. Neurourol Urodyn. 2010;29:1433–8.CrossRefPubMedGoogle Scholar
  25. 25.
    Possover M. Recovery of sensory and supraspinal control of leg movement in people with chronic paraplegia: a case series. Arch Phys Med Rehabil. 2014;95(4):610–4.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2019

Authors and Affiliations

  1. 1.University of Toronto, Women’s College Hospital and Mount Sinais Hospital, Department of Obstetrics and GynecologyTorontoCanada

Personalised recommendations