Neuropelveology: the missing competency in pelvic surgery

To define neuropelveology as a multidisciplinary clinical competence and to examine the diagnostic, therapeutic, and educational gaps that have led to its development as an integrated framework for the management of pelvic nerve disorders.

Narrative and conceptual review of the clinical scope, diagnostic principles, therapeutic approaches, educational requirements, and evolving scientific framework of neuropelveology.

Multidisciplinary pelvic medicine involving gynecology, urology, neurology, colorectal surgery, pain medicine, rehabilitation, neurophysiology, and minimally invasive pelvic nerve surgery.

Patients with disorders of the pelvic nervous system, including pelvic neuropathic pain, sacral radiculopathies, pudendal neuralgia, sciatica, and neurogenic pelvic organ dysfunctions. No specific patient cohort was analyzed in this review.

Neurofunctional assessment, pelvic neuroanatomical evaluation, imaging correlation, minimally invasive pelvic nerve surgery, neuromodulation, and functional rehabilitation are discussed as components of an integrated neuropelveological approach.

Pelvic nerve disorders frequently involve multiple organ systems and therefore extend beyond the traditional boundaries of individual medical specialties, contributing to delayed diagnosis, fragmented care, and repeated ineffective interventions. Advances in laparoscopic and robotic surgery have improved access to pelvic neural structures while emphasizing the need for standardized diagnostic pathways, competency-based training, patient-safety principles, and multidisciplinary collaboration. International guidelines, structured educational pathways, certification programs, and collaborative scientific initiatives developed through the International Society of Neuropelveology (ISON) provide an emerging framework for harmonized clinical practice and education.

Neuropelveology should not be regarded as a new surgical specialty but as a multidisciplinary competence integrating the diagnosis, treatment, education, and scientific development of pelvic nerve disorders. With the expanding roles of pelvic neuromodulation, restorative neurotechnology, and bioelectronic medicine, this framework may contribute to safer, more neurofunctionally oriented, and better integrated pelvic care.