Sacral radiculopathy is an underrecognized complication of sacrocolpopexy and rectopexy, frequently misdiagnosed as spinal pathology. In a retrospective cohort of 38 patients, two entities were identified: early neurogenic radiculopathy due to direct nerve injury and delayed non-neurogenic radiculopathy caused by fibrotic entrapment. All patients underwent laparoscopic nerve decompression without mesh removal. Neurogenic cases showed limited recovery, whereas 76% of non-neurogenic cases achieved significant pain reduction (VAS 7–10 to 1–4). These findings highlight the pelvic origin of symptoms and the limitations of conventional diagnostics. Neuropelveology enables accurate diagnosis and effective treatment, emphasizing early intervention and nerve-preserving surgical strategies.