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Omouri A, Rapacchi S, Duclos J, Niddam R, Bellemare ME, Pirró N. 3D Observation of Pelvic Organs with Dynamic MRI Segmentation: A Bridge Toward Patient-Specific Models. Int Urogynecol J 2024:10.1007/s00192-024-05817-0. [PMID: 38801556 DOI: 10.1007/s00192-024-05817-0] [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: 01/22/2024] [Accepted: 04/24/2024] [Indexed: 05/29/2024]
Abstract
INTRODUCTION AND HYPOTHESIS Female pelvic organ prolapses are common, but their treatment is challenging. Notably, diagnosis and understanding of these troubles remain incomplete. Tridimensional observations of displacement and deformation of the pelvic organs during a strain could support a better understanding and help to develop comprehensive tools for preoperative planning. METHODS The present feasibility study evaluates tridimensional dynamic MRI in 12 healthy volunteers. Tridimensional acquisitions were approximated using five intersecting slices, each recorded twice per second. MRI was performed during rest and strain, with intrarectal and intravaginal contrast gel. Subject-specific dynamic 3D models were built for each volunteer through segmentation. RESULTS For each volunteer, pelvic organs could be segmented in three dimensions with a rate of acquisition of two cycles per second on five slices, allowing for a fluid observation of displacements and deformations during strain. Manual segmentation of a full strain required 2 h and 33 min on average. The upper limit of the rectum and the pelvic floor were the most difficult structures to identify. This technique is limited by its time-consuming manual segmentation, which impedes its implantation for routine clinical use. This method must be tried in patients with pelvic organ prolapse. CONCLUSIONS This multi-planar acquisition technique applied during a dynamic MRI allows for observation of displacement and deformations of pelvic organs during a strain.
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Affiliation(s)
- Adel Omouri
- Aix-Marseille Univ-Service de Chirurgie Digestive et Oncologique-Hôpital de la Timone, 264, Rue Saint-Pierre, 13005, Marseille, France.
| | - Stanislas Rapacchi
- CNRS, CRMBM, Aix-Marseille Univ, 27 Boulevard Jean Moulin, 13005, Marseille, France
| | - Julie Duclos
- Aix-Marseille Univ-Service de Chirurgie Digestive et Oncologique-Hôpital de la Timone, 264, Rue Saint-Pierre, 13005, Marseille, France
| | - Raphaël Niddam
- Aix-Marseille Univ-Service de Chirurgie Digestive et Oncologique-Hôpital de la Timone, 264, Rue Saint-Pierre, 13005, Marseille, France
| | - Marc-Emmanuel Bellemare
- Laboratoire d'Informatique Et Systèmes, équipe I&M - UMR CNRS 7020, Aix-Marseille Université-CNRS, 52, Avenue Escadrille Normandie Niémen, 13397, Marseille Cedex 20, France
| | - Nicolas Pirró
- Aix-Marseille Univ-Service de Chirurgie Digestive et Oncologique-Hôpital de la Timone, 264, Rue Saint-Pierre, 13005, Marseille, France
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DeLancey JO, Mastrovito S, Masteling M, Horner W, Ashton-Miller JA, Chen L. A unified pelvic floor conceptual model for studying morphological changes with prolapse, age, and parity. Am J Obstet Gynecol 2024; 230:476-484.e2. [PMID: 38036167 DOI: 10.1016/j.ajog.2023.11.1247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 11/21/2023] [Accepted: 11/23/2023] [Indexed: 12/02/2023]
Abstract
Several 2-dimensional and 3-dimensional measurements have been used to assess changes in pelvic floor structures and shape. These include assessment of urogenital and levator hiatus dimensions, levator injury grade, levator bowl volume, and levator plate shape. We argue that each assessment reflects underlying changes in an individual aspect of the overall changes in muscle and fascial structures. Vaginal delivery, aging, and interindividual variations in anatomy combine to affect pelvic floor structures and their connections in different ways. To date, there is no unifying conceptual model that permits the evaluation of how these many measures relate to one another or that reflects overall pelvic floor structure and function. Therefore, this study aimed to describe a unified pelvic floor conceptual model to better understand how the aforementioned changes to the pelvic floor structures and their biomechanical interactions affect pelvic organ support with vaginal birth, prolapse, and age. In this model, the pelvic floor is composed of 5 key anatomic structures: the (1) pubovisceral, (2) puborectal, and (3) iliococcygeal muscles with their superficial and inferior fascia; (4) the perineal membrane or body; and (5) the anal sphincter complex. Schematically, these structures are considered to originate from pelvic sidewall structures and meet medially at important connection points that include the anal sphincter complex, perineal body, and anococcygeal raphe. The pubovisceral muscle contributes primarily to urogenital hiatus closure, whereas the puborectal muscle is mainly related to levator hiatus closure, although each muscle contributes to the other. Dorsally and laterally, the iliococcygeal muscle forms a shelflike structure in women with normal support that spans the remaining area between these medial muscles and attachments to the pelvic sidewall. Other features include the levator plate, bowl volume, and anorectal angle. The pelvic floor conceptual model integrates existing observations and points out evident knowledge gaps in how parturition, injury, disease, and aging can contribute to changes associated with pelvic floor function caused by the detachment of one or more important connection points or pubovisceral muscle failure.
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Affiliation(s)
- John O DeLancey
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI
| | - Sara Mastrovito
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI; Department of Obstetrics and Gynecology, Istituto di Ricovero e Cura a Carattere Scientifico, Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy.
| | - Mariana Masteling
- Departments of Mechanical Engineering, University of Michigan, Ann Arbor, MI
| | - Whitney Horner
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI
| | - James A Ashton-Miller
- Departments of Mechanical Engineering, University of Michigan, Ann Arbor, MI; Biomedical Engineering, University of Michigan, Ann Arbor, MI
| | - Luyun Chen
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI
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Lallemant M, Shimojyo AA, Mayeur O, Ramanah R, Rubod C, Kerbage Y, Cosson M. Mobility analysis of a posterior sacrospinous fixation using a finite element model of the pelvic system. PLoS One 2024; 19:e0299012. [PMID: 38512958 PMCID: PMC10956756 DOI: 10.1371/journal.pone.0299012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 02/04/2024] [Indexed: 03/23/2024] Open
Abstract
INTRODUCTION AND HYPOTHESIS In order to improve the knowledge POP physiopathology and POP repair, a generic biomechanical model of the female pelvic system has been developed. In the literature, no study has currently evaluated apical prolapse repair by posterior sacrospinous ligament fixation using a generic model nor a patient-specific model that personalize the management of POP and predict surgical outcomes based on the patient's pre-operative Magnetic Resonance Imaging. The aim of our study was to analyze the influence of a right and/or left sacrospinous ligament fixation and the distance between the anchorage area and the ischial spine on the pelvic organ mobility using a generic and a patient-specific Finite Element model (FEM) of the female pelvic system during posterior sacrospinous ligament fixation (SSF). METHODS Firstly, we used a generic 3D FEM of the female pelvic system previously made by our team that allowed us to simulate the mobility of the pelvic system. To create a patient-specific 3D FEM of the female pelvic system, we used a preoperative dynamic pelvic MRI of a 68 years old woman with a symptomatic stage III apical prolapse and cystocele. With these 2 models, a SSF was simulated. A right and/or left SSF and different distances between the anchorage area and the ischial spine (1 cm, 2 cm and 3 cm.) were compared. Outcomes measures were the pelvic organ displacement using the pubococcygeal line during maximal strain: Ba point for the most posterior and inferior aspect of the bladder base, C point the cervix's or the vaginal apex and Bp point for the anterior aspect of the anorectal junction. RESULTS Overall, pelvic organ mobility decreased regardless of surgical technique and model. According to the generic model, C point was displaced by 14.1 mm and 11.5 mm, Ba point by 12.7 mm, and 12 mm and Bp point by 10.6 mm and 9.9 mm after left and bilateral posterior SSF, respectively. C point was displaced by 15.4 mm and 11.6 mm and Ba point by 12.5 mm and 13.1mm when the suture on the sacrospinous ligament was performed at 1 cm and 3 cm from the ischial spine respectively (bilateral posterior SSF configuration). According to the patient-specific model, the displacement of Ba point could not be analyzed because of a significative and asymmetric organ displacement of the bladder. C point was displaced by 4.74 mm and 2.12 mm, and Bp point by 5.30 mm and 3.24 mm after left and bilateral posterior SSF respectively. C point was displaced by 4.80 mm and 4.85 mm and Bp point by 5.35 mm and 5.38 mm when the suture on the left sacrospinous ligament was performed at 1 cm and 3 cm from the ischial spine, respectively. CONCLUSION According to the generic model from our study, the apex appeared to be less mobile in bilateral SSF. The anchorage area on the sacrospinous ligament seems to have little effect on the pelvic organ mobilities. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04551859.
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Affiliation(s)
- Marine Lallemant
- Service de Gynécologie Obstétrique, Pôle Mère-Femme, Centre Hospitalier Universitaire Jean Minjoz, Besançon, France
- Université Lille, CNRS, Centrale Lille, UMR 9013—LaMcube—Laboratoire de Mécanique, Multiphysique, Multiéchelle, F-59000, Lille, France
| | - Andres Arteaga Shimojyo
- Université Lille, CNRS, Centrale Lille, UMR 9013—LaMcube—Laboratoire de Mécanique, Multiphysique, Multiéchelle, F-59000, Lille, France
| | - Olivier Mayeur
- Université Lille, CNRS, Centrale Lille, UMR 9013—LaMcube—Laboratoire de Mécanique, Multiphysique, Multiéchelle, F-59000, Lille, France
| | - Rajeev Ramanah
- Service de Gynécologie Obstétrique, Pôle Mère-Femme, Centre Hospitalier Universitaire Jean Minjoz, Besançon, France
- Laboratoire de Nanomédecine, Imagerie et Thérapeutiques, INSERM E4 4662, Université de Franche-Comté, Besançon, France
| | - Chrystèle Rubod
- Université Lille, CNRS, Centrale Lille, UMR 9013—LaMcube—Laboratoire de Mécanique, Multiphysique, Multiéchelle, F-59000, Lille, France
- CHU Lille, Service de Chirurgie Gynécologique, F-59000, Lille, France
- Faculté de médecine, Université Lille Nord de France, F-59000, Lille, France
| | - Yohan Kerbage
- Université Lille, CNRS, Centrale Lille, UMR 9013—LaMcube—Laboratoire de Mécanique, Multiphysique, Multiéchelle, F-59000, Lille, France
- CHU Lille, Service de Chirurgie Gynécologique, F-59000, Lille, France
- Faculté de médecine, Université Lille Nord de France, F-59000, Lille, France
| | - Michel Cosson
- Université Lille, CNRS, Centrale Lille, UMR 9013—LaMcube—Laboratoire de Mécanique, Multiphysique, Multiéchelle, F-59000, Lille, France
- CHU Lille, Service de Chirurgie Gynécologique, F-59000, Lille, France
- Faculté de médecine, Université Lille Nord de France, F-59000, Lille, France
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Yang M, Chen C, Wang Z, Long J, Huang R, Qi W, Shi R. Finite element analysis of female pelvic organ prolapse mechanism: current landscape and future opportunities. Front Med (Lausanne) 2024; 11:1342645. [PMID: 38323034 PMCID: PMC10844411 DOI: 10.3389/fmed.2024.1342645] [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: 11/22/2023] [Accepted: 01/05/2024] [Indexed: 02/08/2024] Open
Abstract
The prevalence of pelvic organ prolapse (POP) has been steadily increasing over the years, rendering it a pressing global health concern that significantly impacts women's physical and mental wellbeing as well as their overall quality of life. With the advancement of three-dimensional reconstruction and computer simulation techniques for pelvic floor structures, research on POP has progressively shifted toward a biomechanical focus. Finite element (FE) analysis is an established tool to analyze the biomechanics of complex systems. With the advancement of computer technology, an increasing number of researchers are now employing FE analysis to investigate the pathogenesis of POP in women. There is a considerable number of research on the female pelvic FE analysis and to date there has been less review of this technique. In this review article, we summarized the current research status of FE analysis in various types of POP diseases and provided a detailed explanation of the issues and future development in pelvic floor disorders. Currently, the application of FE analysis in POP is still in its exploratory stage and has inherent limitations. Through continuous development and optimization of various technologies, this technique can be employed with greater accuracy to depict the true functional state of the pelvic floor, thereby enhancing the supplementation of the POP mechanism from the perspective of computer biomechanics.
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Affiliation(s)
- Miyang Yang
- The First Clinical Medical College, The Affiliated People's Hospital of Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China
| | - Chujie Chen
- The First Clinical Medical College, The Affiliated People's Hospital of Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China
| | - Zhaochu Wang
- Department of Anorectal, The Affiliated People's Hospital of Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China
| | - Jiaye Long
- Department of Interventional Radiology, Inner Mongolia Forestry General Hospital, The Second Clinical Medical School of Inner Mongolia University for The Nationalities, Yakeshi, China
| | - Runyu Huang
- The First Clinical Medical College, The Affiliated People's Hospital of Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China
| | - Wan Qi
- Department of Radiology, The Affiliated People's Hospital of Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China
| | - Rong Shi
- Department of Anorectal, The Affiliated People's Hospital of Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China
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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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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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Ogier AC, Rapacchi S, Bellemare ME. Four-dimensional reconstruction and characterization of bladder deformations. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2023; 237:107569. [PMID: 37186971 DOI: 10.1016/j.cmpb.2023.107569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 03/31/2023] [Accepted: 04/24/2023] [Indexed: 05/17/2023]
Abstract
BACKGROUND AND OBJECTIVE Pelvic floor disorders are prevalent diseases and patient care remains difficult as the dynamics of the pelvic floor remains poorly understood. So far, only 2D dynamic observations of straining exercises at excretion are available in the clinics and 3D mechanical defects of pelvic organs are not well studied. In this context, we propose a complete methodology for the 3D representation of non-reversible bladder deformations during exercises, combined with a 3D representation of the location of the highest strain areas on the organ surface. METHODS Novel image segmentation and registration approaches have been combined with three geometrical configurations of up-to-date rapid dynamic multi-slice MRI acquisitions for the reconstruction of real-time dynamic bladder volumes. RESULTS For the first time, we proposed real-time 3D deformation fields of the bladder under strain from in-bore forced breathing exercises. The potential of our method was assessed on eight control subjects undergoing forced breathing exercises. We obtained average volume deviations of the reconstructed dynamic volume of bladders around 2.5% and high registration accuracy with mean distance values of 0.4 ± 0.3 mm and Hausdorff distance values of 2.2 ± 1.1 mm. CONCLUSIONS The proposed framework provides proper 3D+t spatial tracking of non-reversible bladder deformations. This has immediate applicability in clinical settings for a better understanding of pelvic organ prolapse pathophysiology. This work can be extended to patients with cavity filling or excretion problems to better characterize the severity of pelvic floor pathologies or to be used for preoperative surgical planning.
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Affiliation(s)
- Augustin C Ogier
- Aix Marseille Univ, Universite de Toulon, CNRS, LIS, Marseille, France.
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8
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Chen J, Zhang J, Wang F. A finite element analysis of different postures and intra-abdominal pressures for the uterine ligaments in maintaining the normal position of uterus. Sci Rep 2023; 13:5082. [PMID: 36977774 PMCID: PMC10050321 DOI: 10.1038/s41598-023-32368-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 03/27/2023] [Indexed: 03/30/2023] Open
Abstract
Uterine prolapse is a common gynecological disease, which seriously affects the quality of life and physical and mental health of elderly women. The aim of this study was to analyze the influence of different conditions (intra-abdominal pressure (IAP) and posture) on stress and displacement of uterine ligaments using the finite element method, and evaluate the contribution of uterine ligaments on uterus. The three-dimensional (3D) models of retroverted uterus and its accessory ligaments were established, loads and constraints were set in ABAQUS software, and the stress and displacement of uterine ligaments were calculated. The uterine displacement increased with the increase of IAP, and then the stress and displacement of each uterine ligament also increased. The uterine displacement was in the order of forward < upright < backward with different postures, and USL, CL and RL got larger values when the body was backward, while BL got a larger value when the body was forward. With the same condition, the stress of the uterine ligaments was in the order of USL > BL > CL > RL, and the displacement of the ligaments was in the order of BL > RL > USL > CL. The contribution of each uterine ligament changing with different IAP and postures was studied through finite element analysis, and the research results were consistent with the clinical data, which can provide a basis for exploring the mechanism of uterine prolapse.
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Affiliation(s)
- Jialan Chen
- Department of Gynecology, Shaanxi Provincial People's Hospital, Xi'an, 710068, People's Republic of China.
| | - Junfeng Zhang
- School of Mechanical and Electrical Engineering, Xi'an University of Architecture and Technology, Xi'an, 710055, People's Republic of China
| | - Fan Wang
- Department of Gynecology, Shaanxi Provincial People's Hospital, Xi'an, 710068, People's Republic of China
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9
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Doumouchtsis SK, de Tayrac R, Lee J, Daly O, Melendez-Munoz J, Lindo FM, Cross A, White A, Cichowski S, Falconi G, Haylen B. An International Continence Society (ICS)/ International Urogynecological Association (IUGA) joint report on the terminology for the assessment and management of obstetric pelvic floor disorders. Int Urogynecol J 2023; 34:1-42. [PMID: 36443462 PMCID: PMC9834366 DOI: 10.1007/s00192-022-05397-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2022] [Indexed: 11/30/2022]
Abstract
AIMS The terminology of obstetric pelvic floor disorders should be defined and reported as part of a wider clinically oriented consensus. METHODS This Report combines the input of members of two International Organizations, the International Continence Society (ICS) and the International Urogynecological Association (IUGA). The process was supported by external referees. Appropriate clinical categories and a sub-classification were developed to give coding to definitions. An extensive process of 12 main rounds of internal and 2 rounds of external review was involved to exhaustively examine each definition, with decision-making by consensus. RESULTS A terminology report for obstetric pelvic floor disorders, encompassing 357 separate definitions, has been developed. It is clinically-based with the most common diagnoses defined. Clarity and user-friendliness have been key aims to make it usable by different specialty groups and disciplines involved in the study and management of pregnancy, childbirth and female pelvic floor disorders. Clinical assessment, investigations, diagnosis, conservative and surgical treatments are major components. Illustrations have been included to supplement and clarify the text. Emerging concepts, in use in the literature and offering further research potential but requiring further validation, have been included as an Appendix. As with similar reports, interval (5-10 year) review is anticipated to maintain relevance of the document and ensure it remains as widely applicable as possible. CONCLUSION A consensus-based Terminology Report for obstetric pelvic floor disorders has been produced to support clinical practice and research.
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Affiliation(s)
- Stergios K. Doumouchtsis
- grid.419496.7Department of Obstetrics and Gynaecology, Epsom and St. Helier University Hospitals NHS Trust, Epsom, UK
- grid.264200.20000 0000 8546 682XSt. George’s University of London, London, UK
- grid.5216.00000 0001 2155 0800Laboratory of Experimental Surgery and Surgical Research “N.S. Christeas”, National and Kapodistrian University of Athens, Medical School, Athens, Greece
- grid.464520.10000 0004 0614 2595School of Medicine, American University of the Caribbean, Cupecoy, Sint Maarten
- School of Medicine, Ross University, Miramar, FL USA
| | - Renaud de Tayrac
- grid.411165.60000 0004 0593 8241Nimes University Hospital, Nimes, France
| | - Joseph Lee
- grid.1005.40000 0004 4902 0432University New South Wales, Sydney, Australia
| | - Oliver Daly
- grid.417072.70000 0004 0645 2884Western Health, Melbourne, Australia
| | - Joan Melendez-Munoz
- grid.411295.a0000 0001 1837 4818Hospital Universitari Dr. Josep Trueta, Girona, Spain
| | - Fiona M. Lindo
- grid.63368.380000 0004 0445 0041Houston Methodist Hospital, Texas A&M University College of Medicine, Houston Methodist Hospital, Houston, TX USA
| | - Angela Cross
- grid.415534.20000 0004 0372 0644Middlemore Hospital, Auckland, New Zealand
| | - Amanda White
- grid.89336.370000 0004 1936 9924University of Texas at Austin, Austin, TX USA
| | - Sara Cichowski
- grid.5288.70000 0000 9758 5690Oregon Health & Sciences University, Portland, OR USA
| | - Gabriele Falconi
- grid.413009.fComplex Operative Unit of Gynecology, Fondazione Policlinico Tor Vergata University Hospital, Rome, Italy
| | - Bernard Haylen
- grid.1005.40000 0004 4902 0432University New South Wales, Sydney, Australia
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Snyder W, McGuire JA, Mou C, Dillard DA, Iliescu T, De Vita R. Data-driven variational multiscale reduced order modeling of vaginal tissue inflation. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2023; 39:e3660. [PMID: 36333869 DOI: 10.1002/cnm.3660] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 09/04/2022] [Accepted: 10/30/2022] [Indexed: 06/16/2023]
Abstract
The vagina undergoes large finite deformations and has complex geometry and microstructure, resulting in material and geometric nonlinearities, complicated boundary conditions, and nonhomogeneities within finite element (FE) simulations. These nonlinearities pose a significant challenge for numerical solvers, increasing the computational time by several orders of magnitude. Simplifying assumptions can reduce the computational time significantly, but this usually comes at the expense of simulation accuracy. This study proposed the use of reduced order modeling (ROM) techniques to capture experimentally measured displacement fields of rat vaginal tissue during inflation testing in order to attain both the accuracy of higher-fidelity models and the speed of simpler simulations. The proper orthogonal decomposition (POD) method was used to extract the significant information from FE simulations generated by varying the luminal pressure and the parameters that introduce the anisotropy in the selected constitutive model. A new data-driven (DD) variational multiscale (VMS) ROM framework was extended to obtain the displacement fields of rat vaginal tissue under pressure. For comparison purposes, we also investigated the classical Galerkin ROM (G-ROM). In our numerical study, both the G-ROM and the DD-VMS-ROM decreased the FE computational cost by orders of magnitude without a significant decrease in numerical accuracy. Furthermore, the DD-VMS-ROM improved the G-ROM accuracy at a modest computational overhead. Our numerical investigation showed that ROM has the potential to provide efficient and accurate computational tools to describe vaginal deformations, with the ultimate goal of improving maternal health.
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Affiliation(s)
- William Snyder
- STRETCH Lab, Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, Virginia, USA
| | - Jeffrey A McGuire
- STRETCH Lab, Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, Virginia, USA
| | - Changhong Mou
- Department of Mathematics, Virginia Tech, Blacksburg, Virginia, USA
| | - David A Dillard
- Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, Virginia, USA
| | - Traian Iliescu
- Department of Mathematics, Virginia Tech, Blacksburg, Virginia, USA
| | - Raffaella De Vita
- STRETCH Lab, Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, Virginia, USA
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Clark-Patterson G, Domingo M, Miller KS. Biomechanics of Pregnancy and Vaginal Delivery. CURRENT OPINION IN BIOMEDICAL ENGINEERING 2022. [DOI: 10.1016/j.cobme.2022.100386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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12
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Diallo MN, Mayeur O, Lecomte-Grosbras P, Patrouix L, Witz JF, Lesaffre F, Rubod C, Cosson M, Brieu M. Simulation of the mobility of the pelvic system: influence of fascia between organs. Comput Methods Biomech Biomed Engin 2021; 25:1073-1087. [PMID: 34783611 DOI: 10.1080/10255842.2021.2001460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The mobility of pelvic organs is the result of an equilibrium called Pelvic Static characterizing the balance between the properties and geometries of organs, suspensions and support system. Any imbalance in this complex system can cause of pelvic static disorder. Genital prolapse is a common hypermobility pathology which is complex, multi factorial and its surgical management has high rate of complications. The use of 3 D numerical models and simulation enables the role of the various suspension structures to be objectively studied and quantified. Fascias are connective tissues located between organs. Although their role are described as important in various descriptions of pelvic statics, their influence and role has never been quantitatively objectified. This article presents a refine Finite Element (FE) model for a better understanding of biomechanical contribution of inter-organ fascia. The model is built from MRI images of a young volunteer, the mechanical properties derived from literature data to take into account the age of the patient and new experimental results have enabled an order of magnitude of the mechanical properties of the fascias to be defined. The FE results allows to quantify the biomechanical role of the fascia on pelvic mobility quantified by an analysis of dynamic MRI images and a local mapping of the gap between calculated and measured displacements. This improved numerical model integrating the fascias makes it possible to describe pelvic mobilities with a gap of 1 mm between numerical simulations and measurements, whereas without taking them into account this gap locally reaches 20 mm.
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Affiliation(s)
- Mouhamadou Nassirou Diallo
- CNRS, Centrale Lille, UMR 9013 - LaMcube - Laboratoire de Mécanique, Multiphysique, Multiéchelle, University of Lille, Lille, France
| | - Olivier Mayeur
- CNRS, Centrale Lille, UMR 9013 - LaMcube - Laboratoire de Mécanique, Multiphysique, Multiéchelle, University of Lille, Lille, France
| | - Pauline Lecomte-Grosbras
- CNRS, Centrale Lille, UMR 9013 - LaMcube - Laboratoire de Mécanique, Multiphysique, Multiéchelle, University of Lille, Lille, France
| | - Laurent Patrouix
- CNRS, Centrale Lille, UMR 9013 - LaMcube - Laboratoire de Mécanique, Multiphysique, Multiéchelle, University of Lille, Lille, France
| | - Jean François Witz
- CNRS, Centrale Lille, UMR 9013 - LaMcube - Laboratoire de Mécanique, Multiphysique, Multiéchelle, University of Lille, Lille, France
| | - François Lesaffre
- CNRS, Centrale Lille, UMR 9013 - LaMcube - Laboratoire de Mécanique, Multiphysique, Multiéchelle, University of Lille, Lille, France
| | - Chrystle Rubod
- CNRS, Centrale Lille, UMR 9013 - LaMcube - Laboratoire de Mécanique, Multiphysique, Multiéchelle, University of Lille, Lille, France.,Service de chirurgie gynécologique - CHU Lille, Lille, France
| | - Michel Cosson
- CNRS, Centrale Lille, UMR 9013 - LaMcube - Laboratoire de Mécanique, Multiphysique, Multiéchelle, University of Lille, Lille, France.,Service de chirurgie gynécologique - CHU Lille, Lille, France
| | - Mathias Brieu
- CNRS, Centrale Lille, UMR 9013 - LaMcube - Laboratoire de Mécanique, Multiphysique, Multiéchelle, University of Lille, Lille, France.,Department of Mechanical Engineering, College Engineering, Computer Science and Technology, California State University, Los Angeles, Long Angeles, CA, USA
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13
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Biomechanical trade-offs in the pelvic floor constrain the evolution of the human birth canal. Proc Natl Acad Sci U S A 2021; 118:2022159118. [PMID: 33853947 DOI: 10.1073/pnas.2022159118] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Compared with most other primates, humans are characterized by a tight fit between the maternal birth canal and the fetal head, leading to a relatively high risk of neonatal and maternal mortality and morbidities. Obstetric selection is thought to favor a spacious birth canal, whereas the source for opposing selection is frequently assumed to relate to bipedal locomotion. Another, yet underinvestigated, hypothesis is that a more expansive birth canal suspends the soft tissue of the pelvic floor across a larger area, which is disadvantageous for continence and support of the weight of the inner organs and fetus. To test this "pelvic floor hypothesis," we generated a finite element model of the human female pelvic floor and varied its radial size and thickness while keeping all else constant. This allowed us to study the effect of pelvic geometry on pelvic floor deflection (i.e., the amount of bending from the original position) and tissue stresses and stretches. Deflection grew disproportionately fast with increasing radial size, and stresses and stretches also increased. By contrast, an increase in thickness increased pelvic floor stiffness (i.e., the resistance to deformation), which reduced deflection but was unable to fully compensate for the effect of increasing radial size. Moreover, larger thicknesses increase the intra-abdominal pressure necessary for childbirth. Our results support the pelvic floor hypothesis and evince functional trade-offs affecting not only the size of the birth canal but also the thickness and stiffness of the pelvic floor.
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14
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Manzini C, van den Noort F, Grob ATM, Withagen MIJ, van der Vaart CH. The effect of pessary treatment on puborectalis muscle function. Int Urogynecol J 2021; 32:1409-1417. [PMID: 33847771 PMCID: PMC8042456 DOI: 10.1007/s00192-021-04766-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 03/10/2021] [Indexed: 12/25/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The objective was to assess if puborectalis muscle (PRM) function changes in women with pelvic organ prolapse (POP) undergoing pessary treatment. METHODS This was a prospective cohort study of women with symptomatic POP choosing pessary treatment. An interview, clinical examination and 3D/4D transperineal ultrasound were performed at baseline and at 3-month follow-up. POP was assessed using the Pelvic Organ Prolapse Quantification system (POPQ). Parameters compared between baseline and follow-up were: hiatal area at rest (HArest), maximal contraction (HActx), and maximal Valsalva maneuver (HAVal), displacement in contraction (DISPL-ctx, i.e., relative difference between HArest and HActx), and displacement in Valsalva (DISPL-Val, i.e., relative difference between and HAVal and HArest). Parameters were compared in women with and those without complete avulsion. RESULTS A total of 162 women were assessed and 34 were included. Mean age was 64 years (SD 11.4), and mean BMI 24 kg/m2 (SD 3.1). Thirty-one women had a cystocele, 8 a uterine prolapse, and 12 had a posterior compartment prolapse. Twenty-one women (61.8%) had a POP stage II, and 13 (38.2%) a POP stage III. Ring pessaries were most frequently used (97%). In the entire group a statistically significant increase in DISPL-ctx was observed (mean difference 2.1%, p = 0.017). In the no avulsion group HArest and DISPL-ctx increased significantly (mean difference 4.1%, p = 0.016 and 2.7%, p = 0.016 respectively) and the increase in DISPL-ctx was higher than in the avulsion group (mean difference 2.7% vs 0.2%, p = 0.056). CONCLUSION Our results show that PRM function changes in women with POP undergoing pessary treatment and suggest that such change occurs mainly in the absence of complete avulsion.
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Affiliation(s)
- Claudia Manzini
- Department of Reproductive Medicine and Gynecology, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - Frieda van den Noort
- Robotics and Mechatronics, Faculty of electrical engineering mathematics and computer science, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Anique T M Grob
- Multimodality Medical Imaging Group, Faculty of Science and Technology, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Mariëlla I J Withagen
- Department of Reproductive Medicine and Gynecology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Carl H van der Vaart
- Department of Reproductive Medicine and Gynecology, University Medical Center Utrecht, Utrecht, The Netherlands
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15
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Routzong MR, Cook MS, Barone W, Abramowitch SD, Alperin M. Novel Application of Photogrammetry to Quantify Fascicle Orientations of Female Cadaveric Pelvic Floor Muscles. Ann Biomed Eng 2021; 49:1888-1899. [PMID: 33638030 DOI: 10.1007/s10439-021-02747-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 02/04/2021] [Indexed: 11/28/2022]
Abstract
Although critical for understanding and simulating pelvic floor muscle function and pathophysiology, the fascicle arrangements of the coccygeus and levator ani remain mostly undetermined. We performed close-range photogrammetry on cadaveric pelvic floor muscles to robustly quantify surface fascicle orientations. The pelvic floor muscles of 5 female cadavers were exposed through anatomic dissections, removed en bloc, and photographed from every required angle. Overlapping images were mapped onto in silico geometries and muscle fascicles were traced manually. Tangent vectors were calculated along each trace; interpolated to define continuous, 3D vector fields; and projected onto axial and sagittal planes to calculate angles with respect to the pubococcygeal line. Contralateral and ipsilateral pelvic floor muscles were compared within each donor (Kuiper's tests) and using mean values from all donors (William-Watsons tests). Contralateral muscles and all but one ipsilateral muscle pair differed significantly within each donor (p < 0.001). When mean values were considered collectively, no contralateral or ipsilateral statistical differences were found but all muscles compared differed by more than 10° on average. Close-range photogrammetry and subsequent analyses robustly quantified surface fascicle orientations of the pelvic floor muscles. The continuous, 3D vector fields provide data necessary for improving simulations of the female pelvic floor muscles.
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Affiliation(s)
- Megan R Routzong
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Mark S Cook
- Department of Integrative Biology and Physiology, University of Minnesota, Minneapolis, MN, USA
| | - William Barone
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Marianna Alperin
- Department of Obstetrics, Gynecology & Reproductive Sciences, Division of Female Medicine and Reconstructive Surgery, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093-0863, USA.
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16
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Abstract
This theme issue of
Interface Focus
is the first of two sets of articles on the topic of bioengineering in women's health. Although there is a long history of collaboration between engineers and medical professionals in orthopaedics and cardiovascular medicine, there has been growing interest in the last decade for interdisciplinary collaborations in other areas of medical science. This growth is particularly true in the case of women's health, a traditionally underserved area of research in the scientific community where fundamental knowledge of female physiology is still needed. Women's health is a broad category encompassing reproduction, fertility, maternal health, normal and abnormal pregnancy and the sequelae associated with a difficult childbirth. Women's health also includes sex-associated pathology associated with cancer, pain, cardiac disease, osteoporosis and other diseases. This list is not exhaustive with new scientific frontiers developing based on the evolving discourse of medicine for all. This first issue in the series focuses on bioengineering advances in the study of the non-pregnant woman, and the articles highlight important developments in pelvic floor disorders, biomedical devices, fertility, breast implant failure and breast cancer. The second issue in the series focuses on pregnancy.
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Affiliation(s)
- Kristin S. Miller
- Biomedical Engineering, Tulane University, 500 Lindy Boggs Center, New Orleans, LA 70118, USA
| | - Kristin Myers
- Mechanical Engineering, Columbia University, New York, NY 10025, USA
| | - Michelle Oyen
- Department of Engineering, East Carolina University, Greenville, NC, USA
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