THE IMPORTANCE OF NEUROPELVIOLOGY FOR THE TREATMENT OF COLOPROCTOLOGICAL PATIENTS

Introduction Neuropelveology, the field that studies all diagnostic and therapeutic approaches involving pelvic innervation, integrates the specialties of urology, gynecology, and coloproctology. It has become essential in the management of pelvic disorders. Coloproctological patients often face debilitating conditions with various etiologies. Traditionally, treatments have been based on symptomatic approaches with limited results. However, advances in neuropelveology have revolutionized the ability to diagnose and treat pelvic neurological dysfunctions.

Objectives To demonstrate the importance of neuropelveology in coloproctological patients with pelvic floor disorders.

Methods A review was conducted using searches from the PUBMED, BVS, and Scielo databases, with the descriptors “Neuropelveology” associated with “Coloproctology,” “Pelvic Floor Dysfunction,” as well as variable descriptors: “Treatment” and “Diagnosis.”

Results A total of 317 articles were found, of which 11 articles published in the last 10 years with the mentioned descriptors were selected. In coloproctology, the sphincter and pelvic floor muscles, the anal canal, rectum, sigmoid, and left colon function due to nervous stimulations from the sacral roots S2, S3, and S4 through the pudendal nerve and pelvic splanchnic nerves, respectively. Dysfunction of the posterior pelvic compartment is understood to originate from disturbances in the function of these innervations, and the etiology should be investigated through functional and anatomical tests (anorectal manometry, three-dimensional and dynamic endoanal neuro-ultrasonography, and pelvic magnetic resonance imaging). These dysfunctions may stem from vascular entrapment, nerve compression, iatrogenic surgical injuries, endometriosis, among others. The treatment depends on the diagnosis and may range from local botulinum toxin injection, neuromodulation, to minimally invasive laparoscopic or robotic surgery for nerve release.

Conclusion For proper management of pelvic floor dysfunctions, it is crucial to understand pelvic innervations and their functioning. Treating the apparently dysfunctional organ may not be the best choice, as its function is preserved by its innervation. Further studies and research are needed for a better understanding of the diagnostic approach and neuropelveological interventions in coloproctology.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
25 April 2025