The laparoscopic implantation of neuroprothesis to the sacral plexus for therapy of neurogenic bladder dysfunctions after failure of percutaneous sacral nerve stimulation.

OBJECTIVES   To report about our first short series of laparoscopic implantation of neuroprothesis-LION procedure-to the sacral plexus for treatment of different neurogenic bladder dysfunctions in patients in whom percutaneous sacral nerve stimulation (SNS) failed. MATERIAL AND METHODS   A unilateral sacral LION procedure was performed in four patients with a refractary interstitial cystitis, in 13 patients with refractory bladder overactivity (multiple sclerosis N= 8, spina bifida N= 1, incomplete paraplegia N= 2, diabetic cystopathy N= 1), one patient with a neurogenic bladder incontinence by Parkinson syndrome, and in four patients for treatment for bladder atonia (Fowler's syndrome). In all patients, not only previous medical treatments but also SNS by transforaminal implantation had failed. Laparoscopic exposure of the sacral nerves roots S2 to S4/5 is performed by a transperitoneal approach and a quad electrode is placed perpendicular to the sacral nerve roots for postoperative global stimulation of these sacral nerve roots. RESULTS   All procedures were performed successfully by laparoscopy without any complications. The mean operative time for such a procedure was 34 min. In two patients of the series postoperative neuromodulation failed. In all further 19 patients with an actual follow-up varying between three months and three years, neuromodulation is still working successfully. CONCLUSIONS   Our results underscore that the sacral LION procedure to the sacral plexus is effective and safe for treatment divers neurogenic bladder dysfunctions even after failure of the classical percutaneous technique of implantation.