Female patient-specific finite element modeling of pelvic organ prolapse (POP)

Chen, Zhuowei; Joli, Pierre; Feng, Zhi-Qiang; Rahim, Mehdi; Pirrò, N.; Bellemare, Marc‐Emmanuel

doi:10.1016/j.jbiomech.2014.11.039

Cited by 47 publications

(34 citation statements)

References 40 publications

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“…Most soft tissues were modeled as linear elastic materials [13, 14], as it has been found that linear elasticity produces a displacement field similar to that produced using nonlinear elasticity, while benefiting the computation efficiency [19]. However, to better characterize the behaviors of the bladder and LAM, hyperelastic models were adopted [16, 31]. The pelvic bone was modeled as a rigid body because of its much greater stiffness than soft tissues [15].…”

Section: Methodsmentioning

confidence: 99%

“…Computer simulation provides a reliable tool for characterizing dynamic biological processes that are otherwise difficult to observe through traditional techniques [15–24]. Several computer models have been developed to study SUI [15] and pelvic organ prolapse [16, 18], but limited efforts have been made to apply this approach to explore the pathophysiology of SUI in young female athletes [8, 23]. …”

Section: Introductionmentioning

confidence: 99%

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Pelvic floor dynamics during high-impact athletic activities: A computational modeling study

Dias

Peng

Khavari

et al. 2017

Clinical Biomechanics

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Background Stress urinary incontinence is a significant problem in young female athletes, but the pathophysiology remains unclear because of the limited knowledge of the pelvic floor support function and limited capability of currently available assessment tools. The aim of our study is to develop an advanced computer modeling tool to better understand the dynamics of the internal pelvic floor during highly transient athletic activities. Methods Apelvic model was developed based on high-resolution MRI scans of a healthy nulliparous young female. A jump-landing process was simulated using realistic boundary conditions captured from jumping experiments. Hypothesized alterations of the function of pelvic floor muscles were simulated by weakening or strengthening the levator ani muscle stiffness at different levels. Intra-abdominal pressures and corresponding deformations of pelvic floor structures were monitored at different levels of weakness or enhancement. Findings Results show that pelvic floor deformations generated during a jump-landing process differed greatly from those seen in a Valsalva maneuver which is commonly used for diagnosis in clinic. The urethral mobility was only slightly influenced by the alterations of the levator ani muscle stiffness. Implications for risk factors and treatment strategies were also discussed. Interpretation Results suggest that clinical diagnosis should make allowances for observed differences in pelvic floor deformations between a Valsalva maneuver and a jump-landing process to ensure accuracy. Urethral hypermobility may be a less contributing factor than the intrinsic sphincteric closure system to the incontinence of young female athletes.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Pelvic floor dynamics during high-impact athletic activities: A computational modeling study

Dias

Peng

Khavari

et al. 2017

Clinical Biomechanics

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“…3–5 This type of analysis has demonstrated definite interactions between connective tissue and levator factors interact [Figure 2]. 6,7 When muscle damage and ligament failure were combined, a larger cystocele formed compared to what happened with impairment of either element alone.…”

Section: How Do the Pelvic Floor Structures Work Together In Preventimentioning

confidence: 99%

What's new in the functional anatomy of pelvic organ prolapse?

DeLancey¹

2016

Current Opinion in Obstetrics &Amp; Gynecology

109

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Purpose of Review Provide an evidence-based review of pelvic floor functional anatomy related to pelvic organ prolapse. Recent Findings Pelvic organ support depends on interactions between the levator ani muscle and pelvic connective tissues. Muscle failure exposes the vaginal wall a pressure differential producing abnormal tension on the attachments of the pelvic organs to the pelvic side-wall. Birth-induced injury to the pubococcygeal portion of the levator ani muscle is seen in 55% of women with prolapse and 16% of women with normal support. Failure of the connective tissue attachments between the uterus and vagina to the pelvic wall (cardinal, uterosacral, paravaginal) are strongly related with prolapse (effect sizes ~2.5) and are also highly correlated with one another (r ~0.85). Small differences exist with prolapse in factors involving the vaginal wall length and width (effect sizes ~1). The primary difference in ligament properties between women with and without prolapse is found in ligament length. Only minor differences in ligament stiffness are seen. Summary Pelvic organ prolapse occurs due to injury to the levator ani muscles and failure of the connections between the pelvic organs to the pelvic sidewall. Abnormalities of the vaginal wall fascial tissues may play a minor role.

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“…Computer simulation using the finite element method (FEM) has been proven to be a useful tool due to its ability to conveniently simulate various impairment conditions and keep these comparisons based on the same subject, computer simulation using finite element method (FEM) has been proven a useful tool [11]. Several computer models developed from MR images have been reported recently in studies of female pelvic floor dysfunctions such as pelvic organ prolapse [12,13], childbirth related levator ani muscle damages [14,15] and ligament impairment [16]. However, the clinical application of these models and their comparisons to the true dynamic response of the pelvis is limited due to either 1) missing or simplified important anatomical structures (e.g., the bladder, rectum, vaginal canal, uterus are not included [14,15]; buffering fatty tissues are not included [12–16]) or 2) less accurate realization of boundary conditions (e.g., direct inferior displacement is applied on the uterus [13]; intra-abdominal pressure is directly applied on the muscle [16] or vaginal wall [12] that are studied).…”

Section: Introductionmentioning

confidence: 99%

Assessment of urethral support using MRI-derived computational modeling of the female pelvis

et al. 2015

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Introduction and Hypothesis This study aims to assess the role of individual anatomical structures and their combinations to urethral support function. Methods A realistic pelvic model was developed from an asymptomatic female subject’s MR images for dynamic biomechanical analysis using the finite element method. Validation was performed by comparing simulation results with dynamic MR imaging observations. Weaknesses of anatomical support structures were simulated by reducing their material stiffness. Urethral mobility was quantified by examining the urethral axis excursion from rest to the final state (Intra-abdominal pressure = 100cmH2O). Seven individual support structures and five of their combinations were studied. Result Among seven urethral support structures, weakening the vaginal walls, puborectalis muscle and pubococcygeus muscle generated the top three largest urethral excursion angles. A linear relationship was found between urethral axis excursions and intra-abdominal pressure. Weakening all three levator ani components together caused a larger weakening effect than the sum of each individually weakened component, indicating a nonlinearly-additive pattern. The pelvic floor responded to different weakening conditions distinctly: weakening the vaginal wall developed urethral mobility through collapsed vaginal canal while weakening the levator ani showed a more uniform pelvic floor deformation. Conclusions The computational modeling and dynamic biomechanical analysis provides a powerful tool to better understand the dynamics of the female pelvis under pressure events. The vaginal walls, puborectalis and pubococcygeus are the most important individual structures in providing urethral support. The levator ani muscle group provides urethral support in a well-coordinated way with a nonlinearly-additive pattern.

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Female patient-specific finite element modeling of pelvic organ prolapse (POP)

Cited by 47 publications

References 40 publications

Pelvic floor dynamics during high-impact athletic activities: A computational modeling study

Pelvic floor dynamics during high-impact athletic activities: A computational modeling study

What's new in the functional anatomy of pelvic organ prolapse?

Assessment of urethral support using MRI-derived computational modeling of the female pelvis

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