International Urogynecology Journal

, Volume 26, Issue 12, pp 1871–1873 | Cite as

Laparoscopic implantation of neuromodulators for treating urinary dysfunctions and improving locomotion in multiple sclerosis patients

  • Nucelio LemosEmail author
  • Denis Bernardi Bichuetti
  • Renato Moretti Marques
  • Maria S. Conde
  • Acary S. B. Oliveira
  • Manoel J. B. C. Girão
IUJ Video


Introduction and hypothesis

The laparoscopic implantation of neuromodulation electrodes—the LION procedure—was first described as a rescue procedure in patients with local complications of a Brindley procedure. The objective of this video article is to demonstrate the technique for the laparoscopic implantation of electrodes for bilateral neuromodulation of femoral, sciatic and pudendal nerves and describe our initial experience with two multiple sclerosis (MS) patients.


This is a retrospective analysis of two patients with MS and neurogenic detrusor overactivity. A quadripolar electrode was implanted with two poles into the Alcock’s canal and the two other laying over the lumbosacral trunk. The other two electrodes were implanted posteriorly to the femoral nerves.


At the neuromodulation trial, both patients presented a full recovery of urinary symptoms. One of them found it easier to stand up for transfers and daily activities and the other managed to advance from the wheelchair to the walker and both patients received the permanent implant. At 1-year follow up, urinary results were maintained and 1 patient presented a disease relapse, demanding multiple reprogramming sessions.


Our initial observations are encouraging and indicate that the LION procedure seems to produce in MS patients similar results to those observed in patients with spinal cord injury. Patients, however, should be advised that MS is a progressive disease and that the positive effects of neuromodulation can potentially fade with time and that multiple reprogramming sessions might be necessary.


Multiple sclerosis Neuromodulation Urinary incontinence Locomotion Laparoscopy LION procedure 



Laparoscopic implantation of neuroprosthesis


Multiple sclerosis



Written informed consent was obtained from the patient for publication of this video article and any accompanying images


Nucelio Lemos received research grants from Medtronic Inc. and Laborie Inc. and proctorship grants from Medtronic Inc. None of these grants is, however, directly related to the current publication.

None of the co-authors have anything to disclose.

Authors’ contribution

N. Lemos: project development, data collection, manuscript writing; D.B. Bichuetti: project development, manuscript writing; R.M. Marques: project development, data collection; M.S. Conde: project development, data collection A.B... Oliveira: project development, manuscript writing; M.J.B.C. Girão: project development, manuscript writing.

Supplementary material


(MP4 93904 kb)


  1. 1.
    Possover M (2009) The sacral LION procedure for recovery of bladder/rectum/sexual functions in paraplegic patients after explantation of a previous Finetech-Brindley controller. J Minim Invasive Gynecol 16(1):98–101CrossRefPubMedGoogle Scholar
  2. 2.
    Possover M, Schurch B, Henle K (2010) New strategies of pelvic nerves stimulation for recovery of pelvic visceral functions and locomotion in paraplegics. Neurourol Urodyn 29:1433–1438CrossRefPubMedGoogle Scholar
  3. 3.
    Possover M (2014) Recovery of sensory and supraspinal control of leg movement in people with chronic paraplegia: a case series. Arch Phys Med Rehabil 95(4):610–614CrossRefPubMedGoogle Scholar
  4. 4.
    Charlifue SW, Weitzenkamp DA, Whiteneck GG (1999) Longitudinal outcomes in spinal cord injury: aging, secondary conditions, and well-being. Arch Phys Med Rehabil 80(11):1429–1434CrossRefPubMedGoogle Scholar
  5. 5.
    Karlsson AK (2006) Autonomic dysfunction in spinal cord injury: clinical presentation of symptoms and signs. Prog Brain Res 152:1–8CrossRefPubMedGoogle Scholar
  6. 6.
    Anderson KD (2004) Targeting recovery: priorities of the spinal cord-injured population. J Neurotrauma 21(10):1371–1383CrossRefPubMedGoogle Scholar
  7. 7.
    Peters KM, Killinger KA, Boguslawski BM, Boura JA (2010) Chronic pudendal neuromodulation: expanding available treatment options for refractory urologic symptoms. Neurourol Urodyn 29(7):1267–1271CrossRefPubMedGoogle Scholar

Copyright information

© The International Urogynecological Association 2015

Authors and Affiliations

  • Nucelio Lemos
    • 1
    Email author
  • Denis Bernardi Bichuetti
    • 2
  • Renato Moretti Marques
    • 1
  • Maria S. Conde
    • 2
  • Acary S. B. Oliveira
    • 2
  • Manoel J. B. C. Girão
    • 1
  1. 1.Pelvic Neurodysfunction Clinic of the Department of Obstetrics and GynecologyFederal University of São PauloSão PauloBrazil
  2. 2.Neuromuscular Diseases Clinic of the Department of Neurology and NeurosurgeryFederal University of São PauloSão PauloBrazil

Personalised recommendations