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Xu Z, Chen N, Wang B, Yang J, Liu H, Zhang X, Li Y, Liu L, Wu Y. Creation of the biomechanical finite element model of female pelvic floor supporting structure based on thin-sectional high-resolution anatomical images. J Biomech 2023; 146:111399. [PMID: 36509024 DOI: 10.1016/j.jbiomech.2022.111399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 10/28/2022] [Accepted: 11/21/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE The main purpose of this study is to obtain a finite element biomechanical model that accurately mimics pelvic organ prolapse in women, to study pelvic floor supporting structures' biomechanical properties and function. We used thin-sectional high-resolution anatomical images (Chinese Visible Human, CVH) to reconstruct a detailed three-dimensional (3D) biomechanical finite element model of the female pelvic floor supporting structure including cardinal ligament, uterosacral ligament, levator ani muscle (LAM) and perianal body. The Valsalva maneuver was simulated by loading the uterus and bladder with a pressure increasing from 0 to 10 kPa. The stress, strain and displacement of supporting structures were calculated. The cardinal ligament, the uterosacral ligament and the LAM were stressed greatly when the uterus moved downward, and the maximum stress could reach 0.267 MPa, 1.51 MPa and 0.065 MPa respectively, and the maximum strain could reach 0.154, 0.16, 0.265, and the maximum displacement could reach 1.786 cm, 1.946 cm and 0.567 cm. Displacement of the perineal body also occurred, and its stress, strain and displacement were 0.092 MPa, 0.381, 0.73 cm. The stress, strain and displacement of the supporting structure around the urethra were 0.339 MPa, 0.169, 1.491 cm. Our model based on CVH has more detailed anatomical structures, which is superior to that based on MRI. Our simulation results were consistent with previous findings, which verified the unbalance of abdominal pressure and pelvic floor supporting structures will lead to POP, which provide a theoretical basis for pelvic floor anatomy and function as well as obstetrical surgery.
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Affiliation(s)
- Zhou Xu
- Department of Digital Medicine, College of Biomedical Engineering and Medical Imaging, Army Medical University (Third Military Medical University), Chongqing 400038, China
| | - Na Chen
- Department of Digital Medicine, College of Biomedical Engineering and Medical Imaging, Army Medical University (Third Military Medical University), Chongqing 400038, China
| | - Bingyu Wang
- School of Mechanical and Automotive Engineering, Xiamen University of Technology, Xiamen 36204, China
| | - Jingyi Yang
- Department of Digital Medicine, College of Biomedical Engineering and Medical Imaging, Army Medical University (Third Military Medical University), Chongqing 400038, China
| | - Hongjun Liu
- Department of Digital Medicine, College of Biomedical Engineering and Medical Imaging, Army Medical University (Third Military Medical University), Chongqing 400038, China
| | - Xiaoqin Zhang
- Department of Digital Medicine, College of Biomedical Engineering and Medical Imaging, Army Medical University (Third Military Medical University), Chongqing 400038, China
| | - Ying Li
- Department of Digital Medicine, College of Biomedical Engineering and Medical Imaging, Army Medical University (Third Military Medical University), Chongqing 400038, China
| | - Li Liu
- Department of Digital Medicine, College of Biomedical Engineering and Medical Imaging, Army Medical University (Third Military Medical University), Chongqing 400038, China
| | - Yi Wu
- Department of Digital Medicine, College of Biomedical Engineering and Medical Imaging, Army Medical University (Third Military Medical University), Chongqing 400038, China.
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Viannay P, de la Codre F, Brochard C, Thubert T, Meurette G, Legendre G, Venara A. Management and consequences of obstetrical anal sphincter injuries: Review. J Visc Surg 2021; 158:231-241. [PMID: 33454307 DOI: 10.1016/j.jviscsurg.2020.10.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Obstetrical anal sphincter injuries (OASI), formerly referred to as "complete" or "incomplete" perineal tears, are a frequent complication of childbirth. They can lead to intestinal consequences (anal incontinence, ano-genital fistula) or sexual consequences (dyspareunia, genital pain). The complexity of management of OASI lies in the multi-factorial nature of these consequences but also in the frequently lengthy interval before their appearance, often long after childbirth. Indeed, while 2.4% of women in childbirth develop OASI, up to 61% of them will present with anal incontinence15 to 25 years after childbirth. Immediate or delayed repair of the sphincter and perineum within a few hours of injury is therefore the rule, but there is no consensus on longer-term management. The patient must be educated on preventive actions (avoidance of pushing or straining, regularization of stool transit, muscle strengthening, etc.). Early detection of anal incontinence leads to prompt management, which is more effective. This review aims to synthesize the information necessary to provide clear and up-to-date patient information on OASI (risk factors and prevalence), the management of OASI, and the management of eventual complications in the setting of dedicated specialty consultations. Dedicated "post-OASI" consultations by a specialist in ano-perineal pathologies could therefore become a first step in the development of care for women, particularly by removing the "shameful" nature of the symptoms.
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Affiliation(s)
- P Viannay
- Department of visceral and endocrine surgery, CHU d'Angers, 4, rue Larrey, 49933 Angers Cedex 9, France; Faculté de santé d'Angers, Department of Medicine, Angers, France
| | - F de la Codre
- Digestive and endocrine surgery clinic, IMAD, Hôtel Dieu, CHU de Nantes, place Alexis-Ricordeau, 44093 Nantes cedex 01, France
| | - C Brochard
- Department of gastroenterology, CHU Pontchaillou, 2, rue Henri Le Guillou, 35000 Rennes, France
| | - T Thubert
- Department of Obstetrics Gynecology, CHU de Nantes, Place Alexis Ricordeau, 44000 Nantes, France
| | - G Meurette
- Digestive and endocrine surgery clinic, IMAD, Hôtel Dieu, CHU de Nantes, place Alexis-Ricordeau, 44093 Nantes cedex 01, France; UMR INSERM U1235, Faculté de médecine, 1, rue Gaston Veil, 44035 Nantes Cedex, France
| | - G Legendre
- Department of Obstetrics Gynecology, CHU d'Angers, 4, rue Larrey, 49933 Angers Cedex 9, France
| | - A Venara
- Department of visceral and endocrine surgery, CHU d'Angers, 4, rue Larrey, 49933 Angers Cedex 9, France; Faculté de santé d'Angers, Department of Medicine, Angers, France; UMR INSERM U1235, Faculté de médecine, 1, rue Gaston Veil, 44035 Nantes Cedex, France.
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