NEUROPELVEOLOGY

The Story of a Discipline Born From One Vision

WHAT WE TREAT – The Human Reality Behind Pelvic Neuropathies

Pelvic neuropathies affect millions worldwide and remain among the most underdiagnosed disorders in medicine. They cause severe pain, bladder dysfunction, mobility loss, and profound psychological distress — with enormous personal, social, and economic consequences. But beyond the medical terminology lies a devastating human reality.

For many patients, neuropathic pelvic pain becomes a daily torment that governs every movement, every moment, every interaction. For others, conditions such as overactive bladder mean waking up every 20 minutes, night after night, running to the bathroom without rest. They lose sleep, lose energy, lose their social life, and often their employment. Intimacy becomes impossible, relationships suffer, and families become exhausted witnesses of a slow, relentless decline.

These conditions do not only destroy the life of the affected individual, they fracture family dynamics, isolate couples, and erode the emotional stability of entire households. Over the past twenty years, Marc and Silke Possover have cared for countless patients trapped in this downward spiral, too often dismissed, misdiagnosed, or sent into psychiatric care after years of unbearable suffering. Some descend into complete isolation; some even reach the limits of psychological endurance.

Witnessing these destinies - repeatedly, profoundly, and personally - is what led the founders to create the European Neuropathy Foundation. The mission is clear: to intervene earlier, to offer a precise and rapid diagnosis, and to treat not the symptoms but the underlying cause of nerve and pelvic organ dysfunction. By addressing the origin of pain and organ failure, we aim to break the cycle before patients fall into despair, disability, social exclusion, or worse.

The Foundation exists to change these trajectories — to restore dignity, hope, autonomy, and the possibility of a normal life.

Reversing the Burden of Pelvic Neuropathies: The Neuropelveology Approach

Neuropathic pelvic pain affects 4–7% of adults and contributes to Europe’s €300+ billion annual cost of chronic pain. Overactive bladder impacts 12–16% of the population, creating a healthcare burden of €20–25 billion annually. Spinal cord injuries affect 250,000–500,000 people per year, often resulting in lifelong disability and complications costing hundreds of thousands of euros per patient.

Neuropelveology introduces a new way to diagnose and treat these conditions through the precise management of the pelvic and autonomic nervous systems. Depending on the cause, treatment may involve nerve decompression (addressing mechanical vascular entrapment), Genital Nerve Stimulation (GNS) for pelvic organ dysfunction, or the LION procedure, which has already enabled more than 150 spinal cord injured peoples to regain voluntary standing, walking with aids, or electrically assisted movement. These treatments all belong to the expanding field of bioelectronic medicine — the use of targeted neural stimulation to restore function in both visceral organs and the autonomic nervous system. By influencing autonomic pathways, neuromodulation does not only treat pain or bladder dysfunction; it has the potential to impact broader systemic conditions such as depression, osteoporosis, sarcopenia, and the prevention of pressure ulcers.

These secondary complications are common and costly:
– Depression affects 40–50% of patients with chronic pelvic pain (EU cost > €100 billion/year)
– Cognitive decline risk increases by 30% in chronic pain
– Osteoporosis accelerates with immobility (EU cost > €50 billion/year)
– Pressure ulcers occur in 25–40% of mobility-impaired individuals; each can cost €20,000–40,000
– Sarcopenia affects 10–20% of older adults (up to 50% with limited mobility; EU cost > €30 billion/year)

Pelvic neuropathies often trigger the first domino — pain → immobility → systemic decline. Neuropelveology and bioelectronic medicine together offer a unique opportunity to reverse this trajectory, by restoring nerve function, mobility, and organ control — and ultimately, by giving patients back autonomy, dignity, and quality of life.

The Origins of Neuropelveology

Neuropelveology was born from the pioneering work of Prof. Marc Possover more than 25 years ago.
In the mid-1990s, while performing advanced laparoscopic cancer and deep endometriosis surgery, he began exploring anatomical regions that pelvic surgeons were traditionally trained to avoid. Working in these “forbidden zones,” he identified, dissected, and preserved the pelvic nerves—structures long considered unreachable.

This work led to the first nerve-sparing laparoscopic techniques (1995) and opened a completely new field of anatomical and clinical knowledge. Through years of research on cadavers at the University of Jena, he mapped the complex network of sympathetic, parasympathetic, somatic, and autonomic nerves of the pelvis, revealing a hidden system that had never before been described with such depth and precision.

These discoveries formed the basis of a new medical discipline (2005): Neuropelveology - the study, diagnosis, and surgical treatment of pelvic nerve disorders. By integrating advanced laparoscopy with detailed neuroanatomy and functional neurophysiology of the pelvis and lower limbs, Prof. Possover created the first comprehensive framework to understand pelvic neuropathic pain, nerve entrapments, and neurological symptoms related to endometriosis, pelvic surgery, and trauma.

In 2003, he performed the world’s first LION procedure (Laparoscopic Implantation of Neuroprosthesis) in a patient with chronic spinal cord injury, demonstrating for the first time that direct stimulation of pelvic and leg nerves could restore standing and voluntary movements.
In 2005, he introduced the first sacral LION procedure, applying this approach to the treatment of refractory pelvic neuropathic pain and severe overactive bladder syndromes, opening an entirely new therapeutic pathway for patients who had exhausted all existing options.

In 2014, to structure and disseminate this new discipline worldwide, Prof. Possover founded the International Society of Neuropelveology (ISON), establishing formal standards, education, and certification for the next generation of specialists.

Neuropelveology represents a true innovation in modern medicine: a discipline entirely conceived, defined, and developed by a single surgeon, whose groundbreaking vision has transformed the understanding and treatment of pelvic nerve disorders across the globe.

Laparoscopic Pelvic Nerve Surgery

From Nerve Preservation to a New Surgical Discipline

Neuropelveology evolved directly from the early principles of nerve-sparing pelvic surgery. What began in the 1990s as the meticulous protection of pelvic nerves during laparoscopic cancer and endometriosis procedures naturally progressed to something unprecedented: direct laparoscopic neurosurgery of the pelvic nerves.

Over years of innovation, this work expanded from nerve preservation to specialised procedures such as neurolysis, nerve decompression, excision of endometriosis and tumours involving the nerves, treatment of vascular nerve entrapment. For the first time, surgeons could see, understand, and treat the exact anatomical cause of neuropathic pelvic pain.

A Medical Revolution for Patients with Chronic Pelvic Neuropathic Pain

Traditional pain medicine focuses on symptoms - painkillers, injections, neuromodulators - often without addressing the cause. This creates a vicious circle of chronic pain management, long-term medication, side effects, and progressive disability. Neuropelveology breaks this cycle. By identifying and surgically treating the true origin of pain—whether endometriosis, tumours, autoimmune-related connective-tissue fragility, or vascular entrapment—Neuropelveology offers something previously impossible: 1. a chance for real remission or major improvement, 2. without lifelong dependence on pain medication, and 3. with restoration of function rather than suppression of symptoms.

Key Surgical Indications

• Deep Endometriosis of the Pelvic Nerves: Precise laparoscopic dissection preserves nerve fibres while removing infiltrating disease.

• Schwannomas and Other Pelvic Nerve Tumours : Complete removal with maximal nerve preservation.

• Vascular Entrapment of the Pudendal and Sacral Nerves: The most frequent cause of chronic pelvic neuropathic pain, often invisible on MRI but fully treatable under laparoscopy.

Autoimmune and Connective-Tissue Diseases: Two decades of experience have revealed a strong association between connective tissue disorders, autoimmune diseases, and vascular nerve entrapment.

This explains why certain patients develop multifocal nerve compression and complex symptoms.

A New Surgical Frontier

Laparoscopic pelvic nerve surgery is now performed worldwide and forms a central pillar of modern Neuropelveology—a discipline that finally treats the cause rather than the symptoms.

GNS & LION: Introducing Neuromodulation into Women’s Health

A New Therapeutic Path for Gynecology

For decades, neuromodulation remained almost entirely outside the field of gynecology. Globally, only 0.35% of gynecologists treat overactive bladder with neuromodulation, despite OAB being one of the most common conditions in women’s health. In Switzerland, sacral neuromodulation is legally reserved for neuro-urologists and general surgeons, which means that gynecologists—who see and treat the vast majority of women with pelvic dysfunction—have been structurally excluded from offering advanced neuromodulatory therapy. This gap left millions of women without access to a treatment that could radically change their quality of life.

It is precisely this clinical injustice that led to the development of Genital Nerve Stimulation (GNS).

Genital Nerve Stimulation: A New Access to Pelvic Neuromodulation

GNS was designed to bring neuromodulation directly into the hands of gynecologists and into the reality of everyday pelvic medicine. By stimulating the genital branch of the pudendal nerve, GNS acts simultaneously on sensory pathways, pelvic autonomic circuits, and the pelvic floor musculature. This makes it uniquely effective in conditions such as bladder hypersensitivity and overactivity, chronic pelvic pain syndromes, pelvic floor dysfunction, and autonomic imbalance.

For the first time, gynecological patients gained access to a neuromodulatory therapy that is tailored to their physiology and can be performed by their own specialist—without the traditional barriers of urological or neurosurgical gatekeeping. GNS therefore represents a decisive moment in women’s health: the moment neuromodulation entered gynecology.

The LION Procedure: Restoring Mobility and Function in Spinal Cord Injury

Parallel to GNS, Prof. Possover developed the LION Procedure—the laparoscopic implantation of neuroprostheses directly onto the lumbosacral plexus. Applied today in more than 150 spinal cord–injured patients, the LION method has produced some of the most remarkable results ever reported in neuromodulation.

Around 93% of treated individuals are able to stand up independently, without physical assistance. Approximately 70% can walk at least ten meters with crutches or a rollator. A similar proportion recover electrically assisted voluntary knee extension, which allows true functional standing and weight-bearing. These achievements go far beyond classical neuromodulation; they touch the core of human mobility.

In addition, the LION procedure contributes to the prevention and treatment of decubitus ulcers, improves pelvic blood flow, slows down osteoporosis progression through repetitive standing, and enhances autonomic functions such as bladder, bowel, and sexual regulation. It is one of the rare therapies in neuro-rehabilitation that not only improves symptoms but restores lost functions and dignity.

A Unified Vision for Pelvic Neuromodulation

Together, GNS and the LION Procedure have fundamentally reshaped the landscape of pelvic neuromodulation. They extend the field from urology and pain management into gynecology, neuro-rehabilitation, autonomic medicine, and long-term functional restoration. They shift the focus from symptom suppression to physiological reactivation, from passive coping to active recovery, and from chronic dependency to renewed autonomy.

These technologies form the clinical backbone of modern Neuropelveology and prepare the path toward the next frontier: the integration of bioelectronic medicine, systemic neuromodulation, and AI-guided personalised therapy—the foundation of the future E-Body.

Bioelectronic Medicine & AI: The Future of the

E-Body

A New Horizon Beyond Classical Neuromodulation

Bioelectronic medicine extends Neuropelveology far beyond the pelvis. By modulating specific autonomic and motor pathways, electrical stimulation can influence systemic functions — bone metabolism, muscle trophism, immunity, vascular regulation, mood, and neuroplasticity. What began with GNS and the LION Procedure has now evolved into a comprehensive concept: the E-Body, a new model of treating human disease through targeted electrical interfaces.

A Biological System Guided by Intelligent Technology

Artificial intelligence introduces a new dimension to neuromodulation. AI can read, interpret, and predict physiological responses in real time, enabling stimulation that adapts continuously to the patient’s needs. This synergy between biology and machine — between nerve and algorithm — allows therapy to become personalised, dynamic, and self-optimising.

New Therapeutic Fields

The integration of bioelectronic interfaces opens treatment perspectives far beyond traditional indications. Electrical modulation of autonomic pathways may support:

osteoporosis prevention and bone regeneration,
reduction of sarcopenia and metabolic decline,
improvement of mood disorders and depression,
modulation of inflammatory and immune activity,
and future applications in oncology.

The E-Body is not a theoretical vision — it is the natural evolution of 25 years of neuromodulatory innovation.

Towards Intelligent, Whole-Body Neuromodulation

With AI-assisted implants, adaptive algorithms, and next-generation neuroprostheses, Neuropelveology is entering a new chapter in medicine: one in which disease is treated not only chemically but electrically — through precise, personalised activation of the body’s own biological circuits.

Guidelines, Education & ISON Certification

Building the Global Standards of Neuropelveology

Neuropelveology has grown into an international discipline with its own scientific foundations, clinical pathways, and therapeutic algorithms. To guarantee excellence and patient safety worldwide, formal Guidelines in Neuropelveology are currently being developed, defining diagnostic criteria, surgical indications, neuromodulatory protocols, and evidence-based therapeutic pathways. These guidelines mark a decisive moment: the transition of Neuropelveology from a pioneering field to a recognised medical standard.

Education as the Heart of the Discipline

For more than two decades, education has been a central mission of Prof. Possover’s work. Today, training in Neuropelveology is structured, accessible, and available globally. Workshops, cadaveric dissections, webinars, interactive case conferences, and hybrid programs provide physicians with the skills required for pelvic nerve examination, diagnostic reasoning, and surgical or neuromodulatory techniques. Every year, international congresses — in Zurich, Istanbul, Paris and other key cities — bring together specialists from gynecology, neurosurgery, urology, orthopedics, and pain medicine. These meetings create a unique environment for knowledge exchange, innovation, and collaborative research.

ISON Certification: Ensuring Excellence Worldwide

The International Society of Neuropelveology (ISON) serves as the official global authority for education and certification in the field. Its structured certification pathway ensures that clinicians acquire the competencies necessary to offer safe and effective neuropelveological care.

Level 1 Certification provides a complete theoretical foundation through e-learning and webinars.
Level 2 Certification includes hybrid or on-site cadaveric workshops and hands-on training.
Level 3 Certification represents the highest level, reserved for those who master advanced surgery, neuromodulation techniques, clinical diagnostics, and research contributions.

These certifications create a unified international standard and ensure that patients worldwide receive care that reflects the scientific rigor and ethical values of the discipline.

A Global Commitment to Patients

With guidelines, structured education, and formal certification, Neuropelveology is becoming a global movement — united by one purpose:
to understand, treat, and ultimately prevent pelvic neuropathic pain and dysfunction by addressing their true cause.

This educational ecosystem forms the backbone of the European Neuropathy Foundation’s mission: spreading knowledge, supporting clinicians, and bringing life-changing treatments to patients worldwide.