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This document outlines the 2026 ISON Neuropelveological Guidelines, which establish a neurofunctional framework for preserving pelvic nerve integrity during gynecologic procedures. The guidelines emphasize defining nerve-sparing surgery by the preservation of neurological function rather than anatomical exposure, with specific applications noted for radical hysterectomy and deep endometriosis surgery. Key recommendations include tailored neural identification, intraoperative functional mapping, and standardized postoperative surveillance of urinary, colorectal, and sexual functions to prevent secondary damage. This paper is centrally about endometriosis — specifically surgical management of deep infiltrating lesions within the context of pelvic nerve-sparing techniques.
Abstract
This document presents Version 1 (2026) of the ISON Neuropelveological Guidelines for Pelvic Nerve-Sparing Surgery in Gynecology, developed under the auspices of the International Society of Neuropelveology (ISON). The guidelines propose a neurofunctional framework for preserving pelvic neurological function during gynecologic surgery, with particular emphasis on radical hysterectomy for cervical cancer and surgery for deep endometriosis. They integrate the historical development of nerve-sparing surgery, pelvic neurofunctional anatomy, mechanisms of surgical nerve injury, intraoperative electrical stimulation and functional mapping, and postoperative assessment of urinary, colorectal, and sexual function. The central principle is that nerve-sparing surgery should be defined by preservation of neurological function rather than by the extent of anatomical nerve exposure. Neural identification and dissection should be tailored to disease distribution and surgical necessity, while uninvolved neural pathways should remain undisturbed whenever possible. In oncological surgery, nerve preservation must not compromise oncological radicality. Practical recommendations address surgical planning, targeted neural identification, unilateral and bilateral preservation, postoperative functional surveillance, and reporting standards. Particular attention is given to bladder emptying, bladder filling sensation, and the prevention of secondary damage associated with unrecognized postoperative dysfunction. Intended for gynecologic surgeons, gynecologic oncologists, endometriosis specialists, neuropelveologists, and clinicians involved in pelvic functional care, this document provides a framework for surgical practice, training, and future research into the preservation and restoration of pelvic neurological function.
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ISON Neuropelveological Guidelines for Pelvic Nerve-Sparing Surgery in Gynecology
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This document presents Version 1 (2026) of the ISON Neuropelveological Guidelines for Pelvic Nerve-Sparing Surgery in Gynecology, developed under the auspices of the International Society of Neuropelveology (ISON).
The guidelines propose a neurofunctional framework for preserving pelvic neurological function during gynecologic surgery, with particular emphasis on radical hysterectomy for cervical cancer and surgery for deep endometriosis. They integrate the historical development of nerve-sparing surgery, pelvic neurofunctional anatomy, mechanisms of surgical nerve injury, intraoperative electrical stimulation and functional mapping, and postoperative assessment of urinary, colorectal, and sexual function.
The central principle is that nerve-sparing surgery should be defined by preservation of neurological function rather than by the extent of anatomical nerve exposure. Neural identification and dissection should be tailored to disease distribution and surgical necessity, while uninvolved neural pathways should remain undisturbed whenever possible. In oncological surgery, nerve preservation must not compromise oncological radicality.
Practical recommendations address surgical planning, targeted neural identification, unilateral and bilateral preservation, postoperative functional surveillance, and reporting standards. Particular attention is given to bladder emptying, bladder filling sensation, and the prevention of secondary damage associated with unrecognized postoperative dysfunction.
Intended for gynecologic surgeons, gynecologic oncologists, endometriosis specialists, neuropelveologists, and clinicians involved in pelvic functional care, this document provides a framework for surgical practice, training, and future research into the preservation and restoration of pelvic neurological function.
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2026-10-12
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