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Boonya-ananta T, Gonzalez M, Ajmal A, Du Le VN, DeHoog E, Paidas MJ, Jayakumar A, Ramella-Roman JC. Speculum-free portable preterm imaging system. JOURNAL OF BIOMEDICAL OPTICS 2024; 29:052918. [PMID: 38282917 PMCID: PMC10821769 DOI: 10.1117/1.jbo.29.5.052918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 01/02/2024] [Accepted: 01/05/2024] [Indexed: 01/30/2024]
Abstract
Significance Preterm birth is defined as a birth before 37 weeks of gestation and is one of the leading contributors to infant mortality rates globally. Premature birth can lead to life-long developmental impairment for the child. Unfortunately, there is a significant lack of tools to diagnose preterm birth risk, which limits patient care and the development of new therapies. Aim To develop a speculum-free, portable preterm imaging system (PPRIM) for cervical imaging; testing of the PPRIM system to resolve polarization properties of birefringent samples; and testing of the PPRIM under an IRB on healthy, non-pregnant volunteers for visualization and polarization analysis of cervical images. Approach The PPRIM can perform 4 × 3 Mueller-matrix imaging to characterize the remodeling of the uterine cervix during pregnancy. The PPRIM is built with a polarized imaging probe and a flexible insertable sheath made with a compatible flexible rubber-like material to maximize comfort and ease of use. Results The PPRIM device is developed to meet specific design specifications as a speculum-free, portable, and comfortable imaging system with polarized imaging capabilities. This system comprises a main imaging component and a flexible silicone inserter. The inserter is designed to maximize comfort and usability for the patient. The PPRIM shows high-resolution imaging capabilities at the 20 mm working distance and 25 mm circular field of view. The PPRIM demonstrates the ability to resolve birefringent sample orientation and full field capture of a healthy, non-pregnant cervix. Conclusion The development of the PPRIM aims to improve access to the standard of care for women's reproductive health using polarized Mueller-matrix imaging of the cervix and reduce infant and maternal mortality rates and better quality of life.
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Affiliation(s)
- Tananant Boonya-ananta
- Florida International University, Department of Biomedical Engineering, Miami, Florida, United States
| | - Mariacarla Gonzalez
- Florida International University, Department of Biomedical Engineering, Miami, Florida, United States
| | - Ajmal Ajmal
- Florida International University, Department of Biomedical Engineering, Miami, Florida, United States
| | - Vinh Nguyen Du Le
- Florida International University, Department of Biomedical Engineering, Miami, Florida, United States
| | - Edward DeHoog
- Optical Design and Engineering, Long Beach, California, United States
| | - Michael J. Paidas
- Miller School of Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, Miami, Florida, United States
| | - Arumugam Jayakumar
- Miller School of Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, Miami, Florida, United States
| | - Jessica C. Ramella-Roman
- Florida International University, Department of Biomedical Engineering, Miami, Florida, United States
- Florida International University, Herbert Wertheim College of Medicine, Miami, Florida, United States
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2
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Sueters J, Xiao F, Roovers JP, Bouman MB, Groenman F, Maas H, Huirne J, Smit T. Creation of a decellularized vaginal matrix from healthy human vaginal tissue for potential vagina reconstruction: experimental studies. Int J Surg 2023; 109:3905-3918. [PMID: 37755377 PMCID: PMC10720790 DOI: 10.1097/js9.0000000000000727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 08/21/2023] [Indexed: 09/28/2023]
Abstract
BACKGROUND When a disorder causes the absence of a healthy, full-size vagina, various neovaginal creation methods are available. Sometimes dilation or stretching of the vaginal cavity is sufficient, but intestinal or dermal flap tissue is generally required. However, different inherent tissue properties cause complications. Therefore, a lost body part should be replaced with a similar material. The use of organ-specific acellular vaginal tissue carries great potential, as its similar architecture and matrix composition make it suitable for vaginal regeneration. METHODS The authors developed an optimized protocol for decellularization of healthy human vaginal tissue. Resected colpectomy tissue from 12 healthy transgender patients was used. Successful decellularization was confirmed by applying acellular criteria from in-vivo remodeling reports. Suitability as a tissue-mimicking scaffold for vaginal reconstruction was determined by visible structural features, biocompatibility during stretching, and the presence of visible collagen, elastin, laminin, and fibronectin. RESULTS Histological examination confirmed the preservation of structural features, and minimal cellular residue was seen during fluorescence microscopy, DNA and RNA quantification, and fragment length examination. Biomechanical testing showed decreased peak load (55%, P <0.05), strain at rupture (23%, P <0.01), and ultimate tensile stress (55%, P <0.05) after decellularization, while the elastic modulus (68%) did not decrease significantly. Fluorescence microscopy revealed preserved Fibronectin-I/II/III and Laminin-I/II, while Collagen-I and Ficolin-2B were decreased but mostly retained. CONCLUSIONS The absence of cellular residue, moderately altered biomechanical extracellular matrix properties, and mostly preserved structural proteins appear to make our decellularized human vaginal matrix a suitable tissue-mimicking scaffold for vagina transplantation when tissue survival through vascularization and innervation are accomplished in the future.
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Affiliation(s)
- Jayson Sueters
- Department of Gynaecology, Amsterdam Reproduction and Development
| | - Fangxin Xiao
- Department of Human Movement Sciences, Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam
- AMS – Musculoskeletal Health, Amsterdam Movement Sciences, VU Research Institutes
- School of Exercise and Health, Shanghai University of Sport, Shanghai, China
| | - Jan-Paul Roovers
- Department of Obstetrics and Gynecology, Amsterdam Reproduction and Development
| | - Mark-Bram Bouman
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC – location VUmc
| | - Freek Groenman
- Department of Obstetrics and Gynecology, Amsterdam Reproduction and Development
| | - Huub Maas
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC – location VUmc
- Department of Human Movement Sciences, Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam
| | - Judith Huirne
- Department of Gynaecology, Amsterdam Reproduction and Development
| | - Theo Smit
- Department of Gynaecology, Amsterdam Reproduction and Development
- Department of Medical Biology, Amsterdam UMC – location AMC, Amsterdam, The Netherlands
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3
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Buchanan LM, Domingo MJ, White SE, Vanoven TN, Karbasion N, Bersi MR, Pence IJ, Florian-Rodriguez M, Miller KS. Advances in vaginal bioengineering: Applications, techniques, and needs. Curr Res Physiol 2023; 6:100111. [PMID: 38107786 PMCID: PMC10724214 DOI: 10.1016/j.crphys.2023.100111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 10/05/2023] [Accepted: 10/13/2023] [Indexed: 12/19/2023] Open
Affiliation(s)
- Lily M. Buchanan
- University of Texas at Dallas, Department of Bioengineering, 800 W. Campbell Rd, Richardson, TX, 75080, USA
| | - Mari J.E. Domingo
- Tulane University, Department of Biomedical Engineering, 6823 St. Charles Ave, New Orleans, LA, 70118, USA
| | - Shelby E. White
- Tulane University, Department of Biomedical Engineering, 6823 St. Charles Ave, New Orleans, LA, 70118, USA
| | - Triniti N. Vanoven
- University of Texas at Dallas, Department of Bioengineering, 800 W. Campbell Rd, Richardson, TX, 75080, USA
- University of Texas Southwestern Medical Center, Department of Biomedical Engineering, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
| | - Niyousha Karbasion
- Washington University at St. Louis, Department of Mechanical Engineering and Materials Science, 1 Brookings Dr, St. Louis, MO, 63130, USA
| | - Matthew R. Bersi
- Washington University at St. Louis, Department of Mechanical Engineering and Materials Science, 1 Brookings Dr, St. Louis, MO, 63130, USA
| | - Isaac J. Pence
- University of Texas at Dallas, Department of Bioengineering, 800 W. Campbell Rd, Richardson, TX, 75080, USA
- University of Texas Southwestern Medical Center, Department of Biomedical Engineering, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
- University of Texas Southwestern Medical Center, Charles and Jane Pak Center for Mineral Metabolism and Clinical Research, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
- University of Texas Southwestern Medical Center, Department of Internal Medicine, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
| | - Maria Florian-Rodriguez
- University of Texas Southwestern Medical Center, Department of Obstetrics and Gynecology, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
- University of Texas Southwestern Medical Center, Cecil H. and Ida Green Center for Reproductive Biology Sciences, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
| | - Kristin S. Miller
- University of Texas at Dallas, Department of Bioengineering, 800 W. Campbell Rd, Richardson, TX, 75080, USA
- University of Texas Southwestern Medical Center, Department of Biomedical Engineering, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
- University of Texas Southwestern Medical Center, Department of Obstetrics and Gynecology, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
- University of Texas at Dallas, Department of Mechanical Engineering, 800 W. Campbell Rd, Richardson, TX, 75080, USA
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4
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Yerrabelli RS, Palsgaard PK, Hojati A, Johnson AJW. Improving visualization of the cervix during pelvic exams: A simulation using a physical model of the speculum and human vagina as a steppingstone to reducing disparities in gynecological cancers. PLoS One 2023; 18:e0283145. [PMID: 37751425 PMCID: PMC10522035 DOI: 10.1371/journal.pone.0283145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 03/02/2023] [Indexed: 09/28/2023] Open
Abstract
Pelvic exams are frequently complicated by collapse of the lateral vaginal walls, obstructing the view of the cervix. To overcome this, physicians frequently repurpose a glove or a condom as a sheath placed over the speculum blades to retract the lateral vaginal walls. Despite their regular use in clinical practice, little research has been done comparing the relative efficacy of these methods. Better visualization of the cervix can benefit patients by decreasing examination-related discomfort, improving cancer screening accuracy, and preventing the need to move the examination to the operating room under general anesthesia. This study presents a physical model that simulates vaginal pressure being exerted around a speculum. Using it, we conduct controlled experiments comparing the efficacy of different condom types, glove materials, glove sizes, and techniques to place gloves on the speculum. The results show that the best sheath is the middle finger of nitrile-material gloves. They provide adequate lateral wall retraction without significantly restricting the opening of the speculum. In comparison, condoms provide a smaller amount of retraction due to loosely fitting the speculum. They may still be a reasonable option for a different speculum size. However, vinyl-material gloves are an impractical option for sheaths; they greatly restrict speculum opening, occasionally even breaking the speculum, which overcome its retraction benefits. Glove size, condom brand, and condom material (latex vs polyisoprene) had minimal impact. This study serves as a guide for clinicians as they use easily accessible tools to perform difficult pelvic exams. We recommend that physicians consider nitrile gloves as the preferred option for a sheath around a speculum. Additionally, this study demonstrates proof-of-concept of a physical model that quantitatively describes different materials on their ability to improve cervical access. This model can be used in future research with more speculum and material combinations, including with materials custom-designed for vaginal retraction.
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Affiliation(s)
- Rahul Sai Yerrabelli
- Carle Illinois College of Medicine, University of Illinois at Urbana-Champaign, Champaign, Illinois, United States of America
- Carle Foundation Hospital, Urbana, Illinois, United States of America
| | - Peggy K. Palsgaard
- Carle Illinois College of Medicine, University of Illinois at Urbana-Champaign, Champaign, Illinois, United States of America
- Carle Foundation Hospital, Urbana, Illinois, United States of America
| | - Ashkhan Hojati
- Carle Illinois College of Medicine, University of Illinois at Urbana-Champaign, Champaign, Illinois, United States of America
- Carle Foundation Hospital, Urbana, Illinois, United States of America
| | - Amy J. Wagoner Johnson
- Carle Illinois College of Medicine, University of Illinois at Urbana-Champaign, Champaign, Illinois, United States of America
- Grainger College of Engineering, University of Illinois at Urbana Champaign, Urbana, Illinois, United States of America
- Carl R. Woese Institute for Genomic Biology, University of Illinois at Urbana Champaign, Urbana, Illinois, United States of America
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5
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Bouquet JM, Naji R, Armas CA, Roldan V, Selkhi S, Bentley CZ, Zapata I, Fisher J. An Innovative Design for the Vaginal Speculum. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2023; 16:211-218. [PMID: 37790696 PMCID: PMC10542509 DOI: 10.2147/mder.s415558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Accepted: 08/31/2023] [Indexed: 10/05/2023] Open
Abstract
Introduction The main objective of this study is to evaluate the effectiveness of a newly designed vaginal speculum, the Bouquet Speculum, in-vitro. The setting of this study was at Florida International University and involved four senior students in the Department of Biomedical Engineering. Methods A phantom vaginal model was used to test three variables of the Bouquet Speculum (Visibility, Pressure and Gynecologic Tools tests). As this was bench-lab testing with simulated models, no human participants were involved in this study. Results The results of this in-vitro study are as follows: The visibility test demonstrated statistically better visualization of the cervix and the cervical os (sampling area for pap tests) with the Bouquet Speculum over the existing 2-bladed speculum at all intrapelvic pressures; The pressure test demonstrated an equal radial distribution of force, without breakage, across the Bouquet Speculum; The gynecologic tools test demonstrated that the Bouquet Speculum is compatible with the existing speculum and standard gynecologic tools in terms of retrieving samples and accessing the cervical os and entire cervix during gynecologic procedures and screening. Conclusion The gynecologic screening and procedural value of this innovative change in the design of the vaginal speculum could save hundreds of thousands of lives every year, provide a more comfortable exam for the patient, and result in a more efficient and user-friendly provider experience.
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Affiliation(s)
- Jean M Bouquet
- Department of Family Medicine, Rocky Vista University College of Osteopathic Medicine, Englewood, CO, 80112, USA
| | - Rayyan Naji
- Department of Biomedical Engineering, College of Engineering and Computing, Florida International University, Miami, FL, 33174, USA
| | - Carlos A Armas
- Department of Biomedical Engineering, College of Engineering and Computing, Florida International University, Miami, FL, 33174, USA
| | - Valentina Roldan
- Department of Biomedical Engineering, College of Engineering and Computing, Florida International University, Miami, FL, 33174, USA
| | - Shadi Selkhi
- Department of Biomedical Engineering, College of Engineering and Computing, Florida International University, Miami, FL, 33174, USA
| | - Camille Z Bentley
- Department of Family Medicine, Rocky Vista University College of Osteopathic Medicine, Englewood, CO, 80112, USA
| | - Isain Zapata
- Department of Biomedical Sciences, Rocky Vista University College of Osteopathic Medicine, Englewood, CO, 80112, USA
| | - Jensen Fisher
- Medical Humanities Department, Rocky Vista University College of Osteopathic Medicine, Englewood, CO, 80112, USA
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6
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Roshanfar M, Fatehi E, Torkaman T, Ashouri N, Lalani I, Khademi S, Aghili M, Saboukhi A, Gangal M. Toward Patient-specific Pessary to Manage Pelvic Organ Prolapse: Design and Simulation. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2023; 2023:1-4. [PMID: 38083613 DOI: 10.1109/embc40787.2023.10340082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
This study proposed a novel design and personalized approach to developing an intra-vaginal device, also known as a pessary, for the treatment of Pelvic Organ Prolapse (POP). Although POP is likely to have a more diverse dynamic than other health conditions in women, it is currently treated as a "one-shape-fits-all" problem in all cases. Pessaries are conservative devices inserted into the vagina to support its internal structure and predominantly come in a ring shape design. Failure rates as high as 50% within the first year of use have been attributed to the poor design of these pessaries; with symptoms such as irritation, bleeding, and lacerations felt by most users. To address this problem, a new base shape design was proposed and its deformation was examined using Finite Element Analysis (FEA). Based on the anatomical measurements of each patient, the base design can be adjusted accordingly. To demonstrate the effectiveness of the proposed design, a comparative study was conducted with the most commonly used support pessary, also known as the ring pessary. In order to model the large deformation of the pessaries, the hyperelastic constitutive law (Yeoh model) was fitted to the available stress-strain data of SIL 30 (a silicone urethane resin supplied by Carbon Inc.). The results showed that re-directing the reaction forces of the pessary towards the lateral walls, supported by the pelvic bones, could decrease the overall displacement of the pessaries, and provide effective symptomatic relief thereby, delaying or preventing surgical procedures.Clinical relevance- There is a clear clinical need to develop a more effective conservative therapy for managing POP. The personalized pessaries proposed in this paper can be an effective method for providing symptomatic relief and avoiding displacement, compared to the currently available devices on the market. Made-to-measure for each patient, the devices are anatomically suited and can be adjusted throughout a patient's treatment plan to allow for higher compliance and overall success rate.
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7
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Gao L, Wang Y, Wen W, Duan Y, Li Z, Dang E, Li P, Yu L, Zhou C, Lu M, Wang G. Fractional carbon dioxide vaginal laser treatment of stress urinary incontinence: Remodeling of vaginal tissues and improving pelvic floor structures. Lasers Surg Med 2023; 55:268-277. [PMID: 36748855 DOI: 10.1002/lsm.23641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 11/22/2022] [Accepted: 01/27/2023] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To demonstrate remodeling of vaginal biomechanical and physiological properties using vaginal fractional carbon dioxide (CO2 ) laser treatment of stress urinary incontinence (SUI). MATERIALS AND METHODS The study cohort included 26 patients with SUI between October 2019 and November 2020. Patients were treated with two sessions of FemTouch vaginal fractional CO2 laser with a one-month interval. Three subjective assessments were administered to all patients: female sexual function index (FSFI), vaginal health index score (VHIS), and international consultation on incontinence questionnaire-short form (ICIQ-SF). Vaginal tissue biopsies were taken from 6 patients before treatment and one-month after the final treatment. Vaginal tactile imaging (VTI) measurements, ultrasonography, and magnetic resonance imaging (MRI) scans were performed before treatment and 10-12-months after treatment in 10, 9, and 6 patients, respectively. RESULTS The average age of the cohort was 39.5 ± 12.0 years. The overall scores for FSFI, VHIS, and ICIQ-SF significantly improved in patients after each treatment sessions as compared with baseline scores. VTI showed significantly increased pressure resistance of both the anterior and posterior vaginal walls after treatment. Ultrasonography showed significant decreases in bladder neck mobility and urethrovesical angle during the Valsalva maneuver after treatment. MRI scans showed significant decreases in the length of the vaginal anterior wall after treatment. Histological examination confirmed that the laser treatment led to a thicker stratified squamous epithelium layer as compared to the baseline. CONCLUSIONS Our results demonstrated that vaginal fractional CO₂ laser treatment can restore vaginal biomechanical and physiological properties by increasing vaginal tightening and improving pelvic floor structures.
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Affiliation(s)
- Lin Gao
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Yuanli Wang
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Wei Wen
- Department of Urology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yunyan Duan
- Department of Medical Technology, Xi'an Medical University, Xi'an, China
| | - Zhaoyang Li
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Erle Dang
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Peng Li
- Department of Radiology, The Affiliated Hospital of Qingdao Binhai University, Qingdao, China
| | - Lei Yu
- Department of Urology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Chenxi Zhou
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Meiheng Lu
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Gang Wang
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
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8
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Alper E, Aksoy S. Impact of Subablative Erb:Yag Laser Applications on Vaginal Resting and Contraction Pressures. HASEKI TIP BÜLTENI 2023. [DOI: 10.4274/haseki.galenos.2023.8841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
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9
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Mihalečko J, Boháč M, Danišovič Ľ, Koller J, Varga I, Kuniaková M. Acellular Dermal Matrix in Plastic and Reconstructive Surgery. Physiol Res 2022. [DOI: 10.33549/physiolres.935045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Despite significant advances in medical research, plastic surgeons still face a shortage of suitable patient tissues, and soft tissue reconstruction is no exception. In recent years, there has been a rapid boom in the use of acellular dermal matrix (ADM) in reconstructive and aesthetic surgery. ADM is incorporated into the surrounding tissue and gradually replaced by the host's collagen, thus promoting and supporting the healing process and reducing the formation of scar tissue. The main goal of this article is to provide a brief review of the current literature assessing the clinical applications of ADM across a broad spectrum of applications in plastic and reconstructive surgery.
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Affiliation(s)
| | | | | | | | | | - M Kuniaková
- Institute of Medical Biology, Genetics and Clinical Genetics, Faculty of Medicine, Comenius University in Bratislava, Sasinkova 4, 811 08 Slovakia. E-mail:
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10
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Palsgaard P, Yerrabelli RS, Hojati A, Whitmore E. Using a condom or glove to improve pelvic exam visualization: A guide. SAGE Open Med 2022; 10:20503121221146069. [PMID: 36568345 PMCID: PMC9772927 DOI: 10.1177/20503121221146069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 11/30/2022] [Indexed: 12/23/2022] Open
Abstract
Objectives Pelvic exams are a cornerstone of gynecological care, necessary for both regular screenings and diagnostics. The collapse of lateral vaginal walls during a pelvic exam is a frequently encountered problem in clinical practice. Methods Practitioners often utilize tools found in a typical clinical setting to counter this issue, such as a condom or glove over the speculum to prevent the lateral vaginal walls collapsing inward and obscuring cervical views. Results These techniques have been passed down from mentor to mentee over the years, though scarcely described in literature. This article aims to provide instructions on how to use these two methods in clinical practice to improve pelvic exams for the practitioner and the patient. Conclusion Utilizing a condom or glove to prevent lateral vaginal wall collapse has the potential to improve pelvic exams for both practitioners and patients.
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Affiliation(s)
- Peggy Palsgaard
- Carle Illinois College of Medicine, University of Illinois at Urbana-Champaign, Champaign, IL, USA,Carle Foundation Hospital, Urbana, IL, USA,Peggy Palsgaard, Carle Illinois College of Medicine, University of Illinois at Urbana-Champaign, 506 S Matthews Ave, Champaign, IL 6180 1, USA. E-mail:
| | - Rahul S Yerrabelli
- Carle Illinois College of Medicine, University of Illinois at Urbana-Champaign, Champaign, IL, USA,Carle Foundation Hospital, Urbana, IL, USA
| | - Ashkhan Hojati
- Carle Illinois College of Medicine, University of Illinois at Urbana-Champaign, Champaign, IL, USA,Carle Foundation Hospital, Urbana, IL, USA
| | - Elsa Whitmore
- Carle Illinois College of Medicine, University of Illinois at Urbana-Champaign, Champaign, IL, USA,Carle Foundation Hospital, Urbana, IL, USA
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11
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MIHALEČKO J, BOHÁČ M, DANIŠOVIČ Ľ, KOLLER J, VARGA I, KUNIAKOVÁ M. Acellular Dermal Matrix in Plastic and Reconstructive Surgery. Physiol Res 2022; 71:S51-S57. [PMID: 36592440 PMCID: PMC9854008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Despite significant advances in medical research, plastic surgeons still face a shortage of suitable patient tissues, and soft tissue reconstruction is no exception. In recent years, there has been a rapid boom in the use of acellular dermal matrix (ADM) in reconstructive and aesthetic surgery. ADM is incorporated into the surrounding tissue and gradually replaced by the host's collagen, thus promoting and supporting the healing process and reducing the formation of scar tissue. The main goal of this article is to provide a brief review of the current literature assessing the clinical applications of ADM across a broad spectrum of applications in plastic and reconstructive surgery.
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Affiliation(s)
- Ján MIHALEČKO
- 2nd Department of Oncology, Faculty of Medicine, Comenius University and National Cancer Institute, Bratislava, Slovak Republic
| | - Martin BOHÁČ
- 2nd Department of Oncology, Faculty of Medicine, Comenius University and National Cancer Institute, Bratislava, Slovak Republic,Centre for Tissue Engineering and Regenerative Medicine – Translational Research Unit in the Branch of Regenerative Medicine, Faculty of Medicine, Comenius University, Bratislava, Slovak Republic
| | - Ľuboš DANIŠOVIČ
- Centre for Tissue Engineering and Regenerative Medicine – Translational Research Unit in the Branch of Regenerative Medicine, Faculty of Medicine, Comenius University, Bratislava, Slovak Republic,Institute of Medical Biology, Genetics and Clinical Genetics, Faculty of Medicine, Comenius University, Bratislava, Slovak Republic,National Institute of Rheumatic Diseases, Piestany, Slovak Republic
| | - Ján KOLLER
- Department of Burns and Reconstructive Surgery, Faculty of Medicine, Comenius University and University Hospital, Bratislava, Slovak Republic
| | - Ivan VARGA
- National Institute of Rheumatic Diseases, Piestany, Slovak Republic,Institute of Histology and Embryology, Faculty of Medicine, Comenius University, Bratislava, Slovak Republic
| | - Marcela KUNIAKOVÁ
- Institute of Medical Biology, Genetics and Clinical Genetics, Faculty of Medicine, Comenius University, Bratislava, Slovak Republic,National Institute of Rheumatic Diseases, Piestany, Slovak Republic
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12
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Li Y, Dong R, Huang J, Xiao Y, Chen J, Zhang H, Long X. Vaginal Rejuvenation with Acellular Dermal Matrix. Clin Plast Surg 2022; 50:181-187. [DOI: 10.1016/j.cps.2022.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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13
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Nan K, Feig VR, Ying B, Howarth JG, Kang Z, Yang Y, Traverso G. Mucosa-interfacing electronics. NATURE REVIEWS. MATERIALS 2022; 7:908-925. [PMID: 36124042 PMCID: PMC9472746 DOI: 10.1038/s41578-022-00477-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 07/28/2022] [Indexed: 06/15/2023]
Abstract
The surface mucosa that lines many of our organs houses myriad biometric signals and, therefore, has great potential as a sensor-tissue interface for high-fidelity and long-term biosensing. However, progress is still nascent for mucosa-interfacing electronics owing to challenges with establishing robust sensor-tissue interfaces; device localization, retention and removal; and power and data transfer. This is in sharp contrast to the rapidly advancing field of skin-interfacing electronics, which are replacing traditional hospital visits with minimally invasive, real-time, continuous and untethered biosensing. This Review aims to bridge the gap between skin-interfacing electronics and mucosa-interfacing electronics systems through a comparison of the properties and functions of the skin and internal mucosal surfaces. The major physiological signals accessible through mucosa-lined organs are surveyed and design considerations for the next generation of mucosa-interfacing electronics are outlined based on state-of-the-art developments in bio-integrated electronics. With this Review, we aim to inspire hardware solutions that can serve as a foundation for developing personalized biosensing from the mucosa, a relatively uncharted field with great scientific and clinical potential.
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Affiliation(s)
- Kewang Nan
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA USA
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA USA
| | - Vivian R. Feig
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA USA
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA USA
| | - Binbin Ying
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA USA
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA USA
| | - Julia G. Howarth
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA USA
| | - Ziliang Kang
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA USA
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA USA
| | - Yiyuan Yang
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA USA
| | - Giovanni Traverso
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA USA
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA USA
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14
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Gao L, Wen W, Wang Y, Li Z, Dang E, Yu L, Zhou C, Lu M, Wang G. Fractional Carbon Dioxide Laser Improves Vaginal Laxity via Remodeling of Vaginal Tissues in Asian Women. J Clin Med 2022; 11:jcm11175201. [PMID: 36079130 PMCID: PMC9457362 DOI: 10.3390/jcm11175201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 08/30/2022] [Accepted: 09/01/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Vaginal laxity (VL) is characterized by the relaxing of the vaginal wall that affects the quality of life and sexual function of patients. The current management of VL such as Kegel exercises and topical or systemic hormonal replacement results in unsatisfactory outcomes; thus, novel modalities are needed to improve the efficacy. Vaginal fractional carbon dioxide (CO2) laser treatment has shown growing applications for the treatment of VL, but results show nonconformities due to the lack of objective evaluations. In this study, we aimed to validate the clinical efficacy and biophysical benefits of fractional CO2 laser treatment for VL patients with the incorporation of objective approaches. Methods: This is a descriptive study without controls. A total of 29 patients were enrolled and treated with two sessions of FemTouch vaginal fractional CO2 laser, with a one-month interval between sessions. Both subjective and objective measurements, including female sexual function index (FSFI), vaginal health index score (VHIS), vaginal tactile imaging (VTI), and histology were used to validate the clinical efficacy and biophysical benefits after treatment. Results: The overall FSFI scores and VHIS scores after the first and second treatment sessions were significantly higher than the baseline scores (p < 0.01, n = 29). VTI measurements showed a significant increase in maximal pressure resistance (kPa) of both the anterior and posterior vaginal walls at a 10−12-month post-treatment visit compared with pre-treatment controls (p < 0.001; n = 16). Histological examination showed that laser treatment led to increases in the thickness of the stratified squamous epithelium layer and density of connective tissues in the lamina propria. Conclusions: Fractional CO2 vaginal laser treatment can improve both vaginal health and sexual function and restore vaginal biomechanical properties by increasing vaginal tissue tightening and improving vaginal tissue integrity in Asian women. Our data support that fractional CO2 vaginal laser is a valid treatment modality for VL.
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Affiliation(s)
- Lin Gao
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xi’an 710032, China
- Correspondence: (L.G.); (G.W.)
| | - Wei Wen
- Department of Urology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No. 85, Wujin Road, Shanghai 200080, China
| | - Yuanli Wang
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xi’an 710032, China
| | - Zhaoyang Li
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xi’an 710032, China
| | - Erle Dang
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xi’an 710032, China
| | - Lei Yu
- Department of Urology, Xijing Hospital, Fourth Military Medical University, Xi’an 710032, China
| | - Chenxi Zhou
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xi’an 710032, China
| | - Meiheng Lu
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xi’an 710032, China
| | - Gang Wang
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xi’an 710032, China
- Correspondence: (L.G.); (G.W.)
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15
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Lauterbach R, Gruenwald I, Ersheed A, Mattar K, Matanes E, Justman N, Amnon A, Lowenstein L. Tension Free Vaginal Tape for Repair of Stress Urinary Incontinence Affects Vaginal Elasticity and Sexual Function. J Gynecol Surg 2022. [DOI: 10.1089/gyn.2021.0149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Roy Lauterbach
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, and Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Ilan Gruenwald
- Department of Neuro-Urology, Rambam Health Care Campus, and Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Angie Ersheed
- Department of Obstetrics and Gynecology, Ha`emek Medical Center, and Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Kamel Mattar
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, and Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Emad Matanes
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, and Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Naphtali Justman
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, and Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Amit Amnon
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, and Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Lior Lowenstein
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, and Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
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16
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Das M, Hahm KS, LaRocca AA, Luna CA, Mendez K, Hoffman R, Verheyen CA, Kim TG, Wamakima BW, Roche E. A Low-Cost, Easily Deployable Vesicovaginal Fistula Occluding Device for Providing Interim Continence. J Med Device 2022. [DOI: 10.1115/1.4053603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Abstract
Vesicovaginal fistulas (VVFs), abnormal openings between the vagina and bladder, disrupt the lives of millions of people worldwide due to resulting incontinence and infections. VVFs are commonly treated with surgery after the fistula has had time to heal over several months. In low-resource areas, the immediate incontinence often leads to ostracization from the community, and can be devastating for the patient. To occlude the fistula and enable full continence until the patient is able to access surgery, we have designed a three-tiered silicone plug consisting of a bladder-dwelling disc, a mid-fistula disc, and a vagina-dwelling cross-shaped tapered plug, all supported on a central stem.
The device withstands typical expulsion forces from the bladder and does not leak under typical bladder filling or urination pressures. The maximum device expulsion force is 3.69 N and it is watertight up to 100 cmH2O or 9.8 kPa. It is designed to be easily deployed by trained community members without medical qualifications.
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Affiliation(s)
- Madhurima Das
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139
| | - Katie S. Hahm
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139
| | - Ava A. LaRocca
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139
| | - Cecilia Alessandra Luna
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139
| | - Keegan Mendez
- Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA 02139
| | - Rachel Hoffman
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139
| | - Connor A. Verheyen
- Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA 02139
| | - Tesia G. Kim
- Gynecology and Reproductive Biology, Beth Israel Deaconess Medical Center, Boston, MA 02215
| | | | - Ellen Roche
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139
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17
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Matanes E, Linder R, Lauterbach R, Mick I, Matanis J, Abdah-Bortnyak R, Reiss A, Amit A, Lowenstein L. The impact of radiation therapy on vaginal biomechanical properties. Eur J Obstet Gynecol Reprod Biol 2021; 264:36-40. [PMID: 34273752 DOI: 10.1016/j.ejogrb.2021.06.046] [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: 02/28/2021] [Revised: 05/06/2021] [Accepted: 06/27/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE In women with cervical cancer (CC), treatment with radiation causes changes in vaginal biomechanical properties, anatomy and function. The aims of the current study were to objectively assess effects of radiotherapy (RT) on vaginal elasticity, wall mobility and contraction strength; and to evaluate associations of these changes with sexual function. STUDY DESIGN This prospective cohort study was approved by our Institutional Review Board. Between May 2018 and June 2020, women with CC who were candidates for RT were eligible to participate. Participants underwent vaginal tactile imaging (VTI) evaluation and were asked to fill the Female Sexual Function Index (FSFI) questionnaire at the time of first RT session and at a 6-month post-treatment follow up visit. Women who underwent radical hysterectomy, or had pelvic side-wall, pelvic or distant organ metastasis were not included. RESULTS A total of 25 women with locally advanced CC were included in the final analysis. The mean age was 39 ± 2.7 years, the mean BMI was 24.8 ± 2.2 kg/m2 and the median parity was 2 (range: 1-5). Following RT, the mean scores for vaginal elasticity and vaginal tightening were significantly lower than at pre-treatment: 11.3 ± 2.5 vs. 28.3 ± 9, P < 0.0001 and 2.6 ± 0.7 vs. 16.7 ± 3, P < 0.0001, respectively. Following RT, significant decreases were demonstrated in vaginal wall mobility and pelvic muscle contraction strength: from 1.77 ± 0.34 to 0.36 ± 0.15, P < 0.0001 and from 2.55 ± 0.48 to 0.52 ± 0.23, P < 0.0001, respectively. Compared to pre-treatment, post-RT vaginal length was significantly shorter (3.30 ± 0.22 vs. 7.64 ± 0.63, P = 0.0023) and sexual intercourse frequency significantly lower: 1 (range 1-2) vs. 2 (range 1-4), P = 0.014). The mean total FSFI score was significantly lower following RT (6.7 ± 1 vs. 14.5 ± 2.7, P < 0.0001). CONCLUSIONS Women with locally advanced CC who have been treated with RT exhibit persistent vaginal biomechanical changes that compromise sexual activity and result in considerable distress.
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Affiliation(s)
- Emad Matanes
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, and Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Revital Linder
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, and Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Roy Lauterbach
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, and Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Ido Mick
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, and Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Jawad Matanis
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, and Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Roxolyana Abdah-Bortnyak
- Department of Radiation Oncology, Rambam Health Care Campus, and Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Ari Reiss
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, and Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Amnon Amit
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, and Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Lior Lowenstein
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, and Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel.
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18
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Lauterbach R, Gutzeit O, Matanes E, Linder R, Mick I, Aharoni S, Gruenwald I, Wiener Z, Lowenstein L. Vaginal Fractional Carbon Dioxide Laser Treatment and Changes in Vaginal Biomechanical Parameters. Lasers Surg Med 2021; 53:1146-1151. [PMID: 33834503 DOI: 10.1002/lsm.23405] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND OBJECTIVES Vaginal fractional carbon dioxide (CO2 ) laser treatment has emerged in the past two decades as a non-surgical option for vaginal tightening. Mounting evidence supports the effectiveness and safety of this treatment for female sexual dysfunction. A newly developed vaginal tactile imaging (VTI) technique accurately evaluates the biomechanical parameters of the female pelvic floor and vagina, including tissue elasticity, pelvic support, and pelvic muscle function in high definition. In the current study, we evaluated changes in objective biomechanical parameters using VTI, following vaginal CO2 laser treatment for vaginal tightening and sexual dysfunction. STUDY DESIGN/MATERIALS AND METHODS We conducted a prospective cohort between June 2018 and January 2020. Inclusion criteria were vaginal looseness, decreased local sensation during sexual intercourse, and sexual dysfunction. All the participants were treated with a vaginal carbon dioxide laser. They underwent a gynecological evaluation based on the Vaginal Health Index (VHI) and sexual function assessment according to the Female Sexual Function Index (FSFI). Vaginal biomechanical parameters were assessed by VTI. Initial evaluations were performed at the pre-treatment consult visit, 1 week prior to the first treatment and at a 6-month post-treatment follow-up visit. RESULTS Twenty-five women were included in the final analysis. Compared with baseline, the post-treatment mean scores for vaginal elasticity and tightening were higher (54.8 ± 5.2 vs. 41.5 ± 6.3, P = 0.0027 and 1.97 ± 0.25 vs. 1.32 ± 0.31, P = 0.0014, respectively). Post-treatment increases were demonstrated in pelvic muscle contraction strength (25.9 ± 3.5 vs. 16.5 ± 4.2, P = 0.0011) and in reflex pelvic muscle contraction (2.93 ± 0.44 vs. 2.12 ± 0.47, P = 0.0022); the mean FSFI and VHI scores were higher following treatment (28.47 ± 1.73 vs. 21.12 ± 1.58, P = 0.036 and 19.15 ± 1.27 vs. 11.6 ± 0.97, P = 0.0032). CONCLUSIONS The quantification of vaginal biomechanical parameters using VTI technology offers objective evidence of the beneficial effect of vaginal CO2 laser treatment. Lasers Surg. Med. © 2020 Wiley Periodicals LLC.
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Affiliation(s)
- Roy Lauterbach
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, 3525408, Israel
| | - Ola Gutzeit
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, 3525408, Israel
| | - Emad Matanes
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, 3525408, Israel
| | - Revital Linder
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, 3525408, Israel
| | - Ido Mick
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, 3525408, Israel
| | - Saar Aharoni
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, 3525408, Israel
| | - Ilan Gruenwald
- Neuro-urology Unit, Rambam Medical Center, Technion, Faculty of Medicine, Haifa, 3525408, Israel
| | - Zeev Wiener
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, 3525408, Israel
| | - Lior Lowenstein
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, 3525408, Israel
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Predictive Value of Biomechanical Mapping for Pelvic Organ Prolapse Surgery. Female Pelvic Med Reconstr Surg 2021; 27:e28-e38. [PMID: 31625957 DOI: 10.1097/spv.0000000000000786] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVE This study examined biomechanical changes in pelvic floor after urogynecological surgery. METHODS This multisite clinical study was designed to explore changes in tissue elasticity, pelvic support, and certain functions (contractive strength, muscle relaxation speed, muscle motility) after pelvic organ prolapse (POP) surgery. A biomechanical mapping of the pelvic floor was performed before and 4 to 6 months after the surgery. The biomechanical data for 52 parameters were acquired by vaginal tactile imaging for manually applied deflection pressures to vaginal walls and pelvic muscle contractions. The two-sample t-test (P < 0.05) was used to test the null hypothesis that presurgery data in group 1 (positive parameter change after surgery) and presurgery data in group 2 (negative parameter change after surgery) belonged to the same distribution. RESULTS A total of 78 subjects with 255 surgical procedures were analyzed across 5 participating clinical sites. All 52 t-tests for group 1 versus group 2 had P value in the range from 4.0 × 10-10 to 4.3 × 10-2 associating all of the 52 parameter changes after surgery with the presurgical conditions. The P value of before and after surgery correlation ranged from 3.7 × 10-18 to 1.6 × 10-2 for 50 of 52 tests, with Pearson correlation coefficient ranging from -0.79 to -0.27. Thus, vaginal tactile imaging parameters strongly correlated weak pelvic floor presurgery with the positive POP surgery outcome of improved biomechanical properties. CONCLUSIONS Pelvic organ prolapse surgery, in general, improves the biomechanical conditions and integrity of the weak pelvic floor. The proposed biomechanical parameters can predict changes resulting from POP surgery.
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Lauterbach R, Gruenwald I, Matanes E, Matar K, Weiner Z, Lowenstein L. The impact of vaginal hysterectomy and uterosacral ligament suspension on vaginal elasticity and sexual function. Eur J Obstet Gynecol Reprod Biol 2020; 258:29-32. [PMID: 33388488 DOI: 10.1016/j.ejogrb.2020.12.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 10/29/2020] [Accepted: 12/08/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Hysterectomy for benign indications has profound effects on both anatomical and physiological pelvic floor and vaginal properties. Vaginal tactile imaging (VTI) enables the quantification of pelvic floor and vaginal biomechanical properties; this enables objective evaluation of various pelvic floor functions. The purposes of this study were to evaluate via VTI, the changes in vaginal elasticity, mobility and strength, before and after hysterectomy by transvaginal natural orifice transluminal endoscopic surgery (vNOTES) and high utero-sacral ligament suspension (USLS); and to assess associations with sexual function. The objective of the current study was to evaluate the effect of these procedures on vaginal elasticity and sexual function. STUDY DESIGN This prospective cohort study included women who underwent hysterectomy by vNOTES and USLS for the treatment of pelvic organ prolapse (POP). All the women underwent both pre- and postoperative VTI and sexual function evaluation. Vaginal elasticity and wall mobility, and the contraction strength and tone of levator muscles, were measured prior to and 6 months following surgery using VTI. RESULTS A total of 23 women, mean age 56.5 years, with stage 3-4 POP participated. Vaginal elasticity increased from 27.3 ± 8.8 to 34.8 ± 12 (P < 0.05) and Female Sexual Function Index (FSFI) scores increased from 22.17 ± 1.62 to 28.66 ± 1.51 (P < 0.05). No correlation was observed between these results. A statistically significant decrease in the mobility of the anterior vaginal wall was demonstrated, from 7.98 ± 10.6 to 0.83 ± 7.5 (P < 0.0001). CONCLUSIONS VTI showed improvements in vaginal elasticity, mobility and FSFI scores following hysterectomy and POP repair performed by vNOTES.
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Affiliation(s)
- Roy Lauterbach
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, and Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel.
| | - Ilan Gruenwald
- Department of Neuro-Urology, Rambam Health Care Campus, and Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Emad Matanes
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, and Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Kamel Matar
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, and Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Zeev Weiner
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, and Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel; Department of Neuro-Urology, Rambam Health Care Campus, and Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Lior Lowenstein
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, and Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
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21
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Egorov V, Lucente V, VAN Raalte H, Murphy M, Ephrain S, Bhatia N, Sarvazyan N. Biomechanical mapping of the female pelvic floor: changes with age, parity and weight. PELVIPERINEOLOGY 2019; 38:3-11. [PMID: 31341548 PMCID: PMC6656381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Quantitative biomechanical characterization of pelvic supportive structures and functions in vivo is thought to provide insight into the pathophysiology of pelvic floor disorders including pelvic organ prolapse (POP). An innovative approach - vaginal tactile imaging - allows biomechanical mapping of the female pelvic floor to quantify tissue elasticity, pelvic support, and pelvic muscle functions. The objective of this study is to explore an extended set of 52 biomechanical parameters to characterize pelvic floor changes with age, parity, and subject weight for normal pelvic floor conditions. 42 subjects with normal pelvic conditions (no POP, no stress urinary incontinence) were included in the data analysis from an observational, case-controlled study. The Vaginal Tactile Imager (VTI) was used with an analytical software package to automatically calculate 52 biomechanical parameters for 8 VTI test procedures (probe insertion, elevation, rotation, Val-salva maneuver, voluntary muscle contractions in 2 planes, relaxation, and reflex contraction). The ranges, mean values, and standard deviations for all 52 VTI parameters were established. 12 VTI parameters were identified as statistically sen-sitive (p < 0.05; t-test) to the subject age; 9 parameters were identified as statistically sensitive (p < 0.05; t-test) to the subject parity; no sensitivity was found to subject weight. Among the 12 parameters sensitive to women's age, 6 parameters show changes (decrease) in tissue elasticity and 6 parameters show weakness in pelvic muscle functions with age. Among the 9 parameters sensitive to parity, 5 parameters show changes (decrease) in tissue elasticity and 4 parameters show weakness in pelvic muscle functions after giving birth. The biomechanical mapping of the female pelvic floor with the VTI provides a unique set of parameters characterizing pelvic changes with age and parity. These objectively measurable biomechanical transformations of pelvic tissues, support structures, and functions may be used in future research and practical applications.
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Affiliation(s)
| | - Vincent Lucente
- The Institute for Female Pelvic Medicine & Reconstructive Surgery, Allentown, United States
| | | | - Miles Murphy
- The Institute for Female Pelvic Medicine & Reconstructive Surgery, Allentown, United States
| | - Sonya Ephrain
- The Institute for Female Pelvic Medicine & Reconstructive Surgery, Allentown, United States
| | - Nina Bhatia
- Princeton Urogynecology, Princeton, United States
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22
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Egorov V, Lucente V, Shobeiri SA, Takacs P, Hoyte L, van Raalte H. Biomechanical Mapping of the Female Pelvic Floor: Uterine Prolapse Versus Normal Conditions. EC GYNAECOLOGY 2018; 7:431-446. [PMID: 31093608 PMCID: PMC6513001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Quantitative biomechanical characterization of pelvic supportive structures and functions in vivo is thought to provide insight into the pathophysiology of pelvic organ prolapse (POP). Vaginal tactile imaging is an innovative approach to the biomechanical mapping of the female pelvic floor to quantify tissue elasticity, pelvic support, and pelvic muscle functions. The Vaginal Tactile Imager (VTI) records high definition pressure patterns through the vaginal walls under an applied tissue deformation and during pelvic floor muscle contractions. OBJECTIVE The objective of this study is to explore an extended set of 52 biomechanical parameters of the female pelvis for the differentiation and characterization of uterine prolapse relative to normal pelvic floor conditions. METHODS Sixty subjects were included in the data analysis from observational and case-controlled studies. Out of these 60, forty-two subjects had normal pelvic floor conditions and 18 subjects had uterine prolapse (no anterior, no posterior prolapse). The VTI, model 2S, was used with an analytical software package to automatically calculate 52 biomechanical parameters for 8 VTI test procedures (probe insertion, elevation, rotation, Valsalva maneuver, voluntary muscle contractions in 2 planes, relaxation, and reflex contraction). RESULTS The ranges, mean values, and standard deviations for all 52 VTI parameters were established. Twenty-two of 52 parameters were identified as statistically sensitive (p < 0.05; t-test) to the development of uterine prolapse. Among these 21 parameters, 6 parameters show changes (decrease) in tissue elasticity, 5 parameters show deteriorations in pelvic support, and 10 parameters show weakness in muscle functions for uterine prolapsed versus normal conditions. CONCLUSION The biomechanical mapping of the female pelvic floor with the VTI provides a unique set of parameters characterizing uterine prolapse versus normal conditions. These objectively measurable biomechanical transformations of pelvic tissues, support structures, and functions under the prolapse conditions may be useful in future research and practical applications.
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Affiliation(s)
| | - Vincent Lucente
- The Institute for Female Pelvic Medicine and Reconstructive Surgery, Allentown, United States
| | | | - Peter Takacs
- Eastern Virginia Medical School, Norfolk, United States
| | - Lennox Hoyte
- The Pelvic Floor Institute, Tampa, United States
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Egorov V, Shobeiri SA, Takacs P, Hoyte L, Lucente V, van Raalte H. Biomechanical Mapping of the Female Pelvic Floor: Prolapse versus Normal Conditions. ACTA ACUST UNITED AC 2018; 8:900-924. [PMID: 31080695 PMCID: PMC6508651 DOI: 10.4236/ojog.2018.810093] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background: Quantitative biomechanical characterization of pelvic supportive structures and functions in vivo is thought to provide insight into pathophysiology of pelvic organ prolapse (POP). An innovative approach—vaginal tactile imaging—allows biomechanical mapping of the female pelvic floor to quantify tissue elasticity, pelvic support, and pelvic muscle functions. The Vaginal Tactile Imager (VTI) records high definition pressure patterns from vaginal walls under an applied tissue deformation and during pelvic floor muscle contractions. Objective: To explore an extended set of 52 biomechanical parameters for differentiation and characterization of POP relative to normal pelvic floor conditions. Methods: 96 subjects with normal and POP conditions were included in the data analysis from multi-site observational, case-controlled studies; 42 subjects had normal pelvic floor conditions and 54 subjects had POP. The VTI, model 2S, was used with an analytical software package to calculate automatically 52 biomechanical parameters for 8 VTI test procedures (probe insertion, elevation, rotation, Valsalva maneuver, voluntary muscle contractions in 2 planes, relaxation, and reflex contraction). The groups were equalized for subject age and parity. Results: The ranges, mean values, and standard deviations for all 52 VTI parameters were established. 33 of 52 parameters were identified as statistically sensitive (p < 0.05; t-test) to the POP development. Among these 33 parameters, 11 parameters show changes (decrease) in tissue elasticity, 8 parameters show deteriorations in pelvic support and 14 parameters show weakness in muscle functions for POP versus normal conditions. Conclusions: The biomechanical mapping of the female pelvic floor with the VTI provides a unique set of parameters characterizing POP versus normal conditions. These objectively measurable biomechanical transformations of pelvic tissues, support structures, and functions under POP may be used in future research and practical applications.
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Affiliation(s)
| | | | | | | | - Vincent Lucente
- The Institute for Female Pelvic Medicine & Reconstructive Surgery, Allentown, USA
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