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

Yinjun Gu,Chen Jiang,Jianwei Lv,Tingting Lv

doi:10.3389/fnins.2021.619672

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.

Highlights

Neuromodulation is an emerging medical field, and it has been shown to be an effective treatment for a variety of pelvic floor diseases and other diseases such as overactive bladder (Salima et al, 2017), interstitial cystitis (Han et al, 2018), and neurogenic bladder (Kessler et al, 2010)
All patients who underwent surgery underwent postoperative pelvic floor computed tomography to assess whether the electrode position was adapted to the pudendal nerve and sacral nerve (Figure 9)
Five patients did not have a permanent stimulator, two patients were implanted with the sacral nerve, and nine patients were implanted with the perineal nerve

Summary

Introduction

Neuromodulation is an emerging medical field, and it has been shown to be an effective treatment for a variety of pelvic floor diseases and other diseases such as overactive bladder (Salima et al, 2017), interstitial cystitis (Han et al, 2018), and neurogenic bladder (Kessler et al, 2010). The neural regulation of pelvic floor diseases mainly utilizes sacral nerve regulation (Zhang et al, 2019). Sacral neuromodulation therapy was proposed by Schmidt et al (1979) for the treatment options of lower urinary tract functional disorders. In the past 5 years, nearly 60 centers in China have carried out SNM clinical studies, and there are several clinical articles published in China that report the efficacy and prognosis of SNM (Chen et al, 2014; Zhang et al, 2017). Researchers are exploring other pelvic floor and peripheral nerves as new regulatory targets to achieve better efficacy and reduce associated

Methods

Results

Conclusion