Endometriosis of the Pelvic Nerves

Endometriosis involving the pelvic nerves is perhaps the most challenging scenario faced by the endometriosis surgeon. The diagnosis is difficult as in most cases imaging and other investigations can be unhelpful and the clinician needs to rely on the clinical picture. Surgery to excise endometriosis of the sacral nerve roots and the sciatic nerve requires in-depth knowledge of pelvic anatomy and skills and experience in working around a rich network of nerves and vessels in the depth of the pelvis. This falls under the remits of neuropelveology, a new discipline in medicine which is a bridge between multiple specialties and fills the gap when conventional surgical approaches in those specialties are not fit for purpose. In this chapter, we provide a didactic overview of pelvic functional neuroanatomy and discuss the diagnosis and surgical treatment of endometriosis of somatic pelvic nerves, using a neuropelveological approach.