3D finite element modeling of pelvic organ prolapse

Yang, Zhuo; Hayes, Jaclyn; Krishnamurty, Sundar; Grosse, Ian R.

doi:10.1080/10255842.2016.1186662

Cited by 14 publications

(34 citation statements)

References 53 publications

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“…Only similar cases (selected from the 41 472 ones) could be compared with previous empirical or simulation data. For instance, some references reported that the vaginal displacement at high IAP loading and ligament impairment is near 33 mm . This study calculated the maximum downward vaginal displacement as 22.5 mm.…”

Section: Discussionmentioning

confidence: 82%

“…Although some previous studies used these element types in their FE analyses, recent researches developed more geometrically precise models of the pelvic components based on advanced imaging techniques . Besides, the material properties of the pelvic components were characterized and somewhere used as non‐linear elastic . Another simplification was related to absence of the deeper parts of the organs (bladder, uterus, colon) and contacts between the soft tissue components.…”

Section: Discussionmentioning

confidence: 99%

“…More recently, Chanda et al utilized a 3D MRI‐based model of uterus, bladder, and vagina to simulate the effects of filled bladder and degrees of prolapse reflected in the material properties of the vaginal wall to indicate that filling of the bladder has larger effects on vaginal wall stress than the loosening tissues. Also, Yang et al employed a patient‐specific 3D model of uterus, cervix, and vagina which are supported by CL and USL. They used hyper‐elastic materials for soft tissues and applied two levels of the IAP on the top of the uterus and vaginal wall to conclude that the ligament impairment has trivial effects on the prolapse in contrast to the IAP which dramatically increases the vaginal wall deformation.…”

Section: Introductionmentioning

confidence: 97%

“…POP occurs when the structural support of the muscles, connective tissues and/or nerves are lost or impaired. Therapeutic strategies for the POP include non‐surgical options like pelvic floor muscle training (PFMT) or hormone therapy and surgical options, for example, removing the prolapsed organ, implanting a mesh prosthesis to hold the pelvic organs up, etc . From a practical point of view, it is crucial to assess the role of the elements in the pelvic structure (eg, ligaments, muscles, etc.)…”

Section: Introductionmentioning

confidence: 99%

“…Some of these models have dealt with effects of mechanical factors like extreme stretch of the pelvic tissues during vaginal delivery, bladder filling, defecatory loading, and different physical conditions for the intra‐abdominal pressure (IAP) on the POP . However, others focused on the contribution of pathological factors like ligament and muscle strength weakening to the occurrence of the POP . For instance, Chen et al first used a 2D model of the pelvic floor including spring elements for pubovisceral muscle, uterosacral (USL) and cardinal (CL) ligaments, deformable shell for vaginal wall, and rigid parts for other parts like the bone and levator ani (LA) muscles to find that the defects in the pubovisceral muscle are more crucial than that of the apical support on the prolapse of the anterior vaginal wall.…”

Section: Introductionmentioning

confidence: 99%

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Three‐dimensional finite element analysis of the pelvic organ prolapse: A parametric biomechanical modeling

Babayi

Azghani²,

Hajebrahimi

et al. 2018

Neurourology and Urodynamics

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Aims To evaluate the role of soft tissue and ligaments damage and level of pelvic muscles activation versus intra‐abdominal pressure, on pelvic organ prolapse. Methods This was a computational modeling based on the finite element analysis. Three pelvic muscles, four pelvic ligaments, and three organs (urethra, vagina, and rectum) were simulated. The model was subjected to total 41 472 analysis cases including three intra‐abdominal pressures, two damaging levels for the ligaments, three damaging levels for the muscles, and four intentional levels of activation for muscles. Results Increased intra‐abdominal pressures caused significant statistical increase of the pelvic organ prolapse (P = 0.000) up to 10 mm downward. Ligaments’ defect had no statistically‐significant effect on prolapse of the organs (P = 0.981 for rectum, P = 0.423 for urethra, and P = 0.752 for vagina). Damage in the pelvic floor muscles and low intentional level of activation also deteriorated the prolapse (P = 0.000). Conclusion Increase of the intra‐abdominal pressure (IAP) as may be existed during pregnancy or physical activity increased the organ prolapse. Damages of the ligaments caused less effects on the prolapse. Loss of the passive properties of the muscles which is probable after delivery or aging moderately deteriorated the prolapse disorder. However, activation of the pelvic floor muscles prevented the prolapse. Different recruitments of the muscles, specifically the pubococcygeus (PCM), could compensate the possible defects in other tissues. Targeted pelvic floor muscle training (PFMT) could also be effective in older adults due to considerable role of the pelvic muscles’ intentional activation.

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Section: Discussionmentioning

confidence: 82%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Three‐dimensional finite element analysis of the pelvic organ prolapse: A parametric biomechanical modeling

Babayi

Azghani²,

Hajebrahimi

et al. 2018

Neurourology and Urodynamics

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A 2D equivalent mechanical model of the whole pelvic floor and impairment simulation

Xie

Yao

et al. 2022

Numer Methods Biomed Eng

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We developed a complete 2D equivalent mechanical model of the pelvic floor based on magnetic resonance imaging (MRI) images of a 35-year-old healthy woman. This model can simulate anterior vaginal prolapse (AVP) due to soft tissue impairment. Thus, we can study the mechanism of prolapse formation from a mechanical perspective and improve the assessment and treatment of the condition in clinical practice. Based on 2D MRI image parameter measurements and computer-aided design methods, the 2D equivalent mechanical model of the whole pelvic floor in the sagittal plane was accurately reconstructed, which includes all necessary tissues of the pelvic floor system. Material parameters were mainly from the literature. We simulated the impairment by reducing the tissue's mechanical properties, and numerical simulations predicted the mechanical response and morphological changes of the healthy and impaired pelvic floor in different states. In six intra-abdominal pressure (IAP) states (8.4-208.9 cmH 2 O), the maximum cervical descent in the impaired pelvic floor was 0.3-18.521 mm, which was much greater than that in the healthy pelvic floor (0.14-6.55 mm). Once the impairment occurred (0%-25%), there was a significant increase in maximum displacement, stress, and cervical descent (30.9-36.5 mm, 0.56-1.12 MPa, 4.6-12.1 mm), and a clinically similar prolapse shape occurred. Simple supine and standing will not cause prolapse. The formation of prolapse is closely related to vaginal tissue impairment. In the standing position, the main forces on the healthy pelvic floor system are distributed horizontally posteriorly and inferiorly, reducing the burden in the vertically downward direction.

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