Interdisziplinäre laparoskopische Implantation von Neuromodulationselektroden am Plexus sacralis (ILIAS) als therapeutische Option bei chronischen Beckenschmerzen und neurogener Blasenfunktionsstörung bei Endometriose

After endometriosis and endometriosis treatment a therapy-associated chronic pelvic pain (CPP) and bladder/bowel dysfunctions may remain due to the damage of neural structures. Interdisciplinary Laparoscopic Implantation of neuromodulAtion leadS (ILIAS) to the sacral plexus could relief pain and improve the bladder/bowel function simultaneously after one surgical procedure. The aim of this study is to show the effect of this interdisciplinary procedure in relation to pain relief, improvement of quality of life and bladder dysfunction.

22 patients suffering from chronic pelvic pain and, bladder and bowel dysfunction underwent laparoscopic exposure and nerve identification with the help of electrophysiological neuromonitoring. A lead was placed laparoscopically in direct contact with the affected nerves (L5-S3). Bladder function, pain medication history, outpatient clinics visits, pain intensity (numerous ranking scale [NRS]), generic health status (EQ-5D-5L), Becks Depressions Inventory (BDI-V), Pain Catastrophizing Scale (PCS), and Client Satisfaction Questionnaire (CSQ-8) were assessed pre- and postoperatively as well as 3 and 6 months after surgery. Statistical analysis was performed using Mann-Whitney U and Wilcoxon rank-sum test.

The average age of the patients was 32.8 years. A significant improvement in bladder function and a reduction in pain medication were achieved. Compared to baseline values, NRS (p<0.001), EQ-5D-5L (p<0.001), BDI-V (p<0.001), and PCS (p<0.001) showed significant improvement. The number of outpatient clinic visits by patients decreased due to adequate therapy and improvement in quality of life. In addition, the CSQ-8 showed that patients were satisfied with the treatment.

The ILIAS method is an effective treatment option for chronic pelvic pain and bladder dysfunctions. Significant pain reduction, improvement of quality of life and depressive mood, as well as improvement of the bladder function was achieved. Further, a significant reduction of the pain medication was seen. The method requires further evaluation of cost savings after the surgery compared to the conventional therapy.