Neuromodulation of the Pudendal Nerve Assisted by 3D Printed: A New Method of Neuromodulation for Lower Urinary Tract Dysfunction

Abstract

Electrical stimulation of peripheral nerves by implanted electrodes is an effective treatment for certain pelvic floor diseases. As well as intravesical electrical stimulation, this predominantly includes stimulation of the sacral nerve, tibial nerve, and pudendal nerve. The pudendal nerve is one of the main nerves that stimulate pelvic floor muscles, external urethral meatus, and the anal sphincter and pelvic organs, and it may have effects on frequent urination, urgency, dysuria, and perineal pain. It is difficult to locate because of its anatomical course, however, leading to difficulties fixing the electrode, which increases the difficulty of pudendal nerve electrical stimulation in clinical practice. In the current study 3D printed navigation was used to solve these problems. Combined with autopsy data and patient pelvic and nerve data, a personalized design was generated. Neural modulation of the pudendal nerve was achieved by implanting the lead with the guidance of 3D printed navigation. 3D printed navigation can maximize the phase II conversion rate, reduce the difficulty of surgery, shorten the operation time, reduce damage to additional organs and blood vessels, and increase the accuracy of electrode implantation, and it can be performed while the patient is awake. It is an accurate, reversible, efficient, and minimally invasive surgery.

Evolving types of pudendal neuromodulation for lower urinary tract dysfunction

“…Gu et al [ 31 ] tried a novel technique designed to assist the surgeon in placing the lead, achieving the closest position to the pudendal nerve with the lowest possible risk of damaging other organs, under the guidance of a 3D printed model. They successfully treated 16 patients, describing the surgical method as accurate, reversible, efficient, and minimally invasive.…”

Current role of neuromodulation in bladder pain syndrome/interstitial cystitis

“…A group of urologists of the Renji Hospital and the Shanghai Jiao Tong University School of Medicine has also reported the practicability of printing a 3D template for needle insertion with previous anatomical study with computed tomography scan for the sacral bone and magnetic resonance imaging for nerves and blood vessels. 37 …”

“…Table 2 summarizes the reports of different case series focused on chronic pudendal nerve stimulation in pelvic pain disorders. 30 – 32 , 36 , 37 , 42 – 45 …”

“…A group of urologists of the Renji Hospital and the Shanghai Jiao Tong University School of Medicine has also reported the practicability of printing a 3D template for needle insertion with previous anatomical study with computed tomography scan for the sacral bone and magnetic resonance imaging for nerves and blood vessels. 37 Possover described in 2004 the feasibility of laparoscopic pelvic autonomous and somatic nerve exposure and evaluation. 38 However, 3 years later, he leaded the report of the Laparoscopic Implantation Of Neuroprosthesis (LION) procedure 30 for patients with pelvic intractable neuralgia using the On-Point™ peripheral nervestimulating electrode and the Interstim™ permanent neurostimulation system (Medtronic Inc., Minneapolis, MN, USA).…”

Can we improve techniques and patients' selection for nerve stimulation suitable for lower urinary tract dysfunctions? ICI‐RS 2023

“…We could work on technique improvement, device programming, and/or patient selection. Recent refinement of the surgical technique for lead placement (Magnetic Resonance 3D or Fusion Ultrasound/X‐ray) 11 and new practical algorithms for initial programming of SNS 12 have resulted in improved short‐ and midterm treatment success. In this effort, scientific cooperation with device companies should be embraced to further research and support technologically advanced, innovative procedures and improvements to existing treatment techniques.…”