Pathophysiological aspects of cystocele with a 3D finite elements model

Lamblin, G.; Mayeur, Olivier; Giraudet, Géraldine; Gautier, Estelle Jean Dit; Chêne, Geneviève; Brieu, Mathias; Rubod, Chrystèle; Cosson, Michel

doi:10.1007/s00404-016-4150-6

Cited by 13 publications

(16 citation statements)

References 29 publications

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“…Through representing a different physiopathological situation, a similar effect of the fascia impairment has been recently observed for the phenomenal development of the cystocele. Symptoms are dramatic after 40% impairment of the pubocervical fascia [ 74 ].…”

Section: Resultsmentioning

confidence: 99%

Modelling of Soft Connective Tissues to Investigate Female Pelvic Floor Dysfunctions

Bhattarai

Staat

2018

Computational and Mathematical Methods in Medicine

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After menopause, decreased levels of estrogen and progesterone remodel the collagen of the soft tissues thereby reducing their stiffness. Stress urinary incontinence is associated with involuntary urine leakage due to pathological movement of the pelvic organs resulting from lax suspension system, fasciae, and ligaments. This study compares the changes in the orientation and position of the female pelvic organs due to weakened fasciae, ligaments, and their combined laxity. A mixture theory weighted by respective volume fraction of elastin-collagen fibre compound (5%), adipose tissue (85%), and smooth muscle (5%) is adopted to characterize the mechanical behaviour of the fascia. The load carrying response (other than the functional response to the pelvic organs) of each fascia component, pelvic organs, muscles, and ligaments are assumed to be isotropic, hyperelastic, and incompressible. Finite element simulations are conducted during Valsalva manoeuvre with weakened tissues modelled by reduced tissue stiffness. A significant dislocation of the urethrovesical junction is observed due to weakness of the fascia (13.89 mm) compared to the ligaments (5.47 mm). The dynamics of the pelvic floor observed in this study during Valsalva manoeuvre is associated with urethral-bladder hypermobility, greater levator plate angulation, and positive Q-tip test which are observed in incontinent females.

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Section: Resultsmentioning

confidence: 99%

Modelling of Soft Connective Tissues to Investigate Female Pelvic Floor Dysfunctions

Bhattarai

Staat

2018

Computational and Mathematical Methods in Medicine

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“…This approach allows moving towards the patient‐specific treatment. Indeed, this work based on medical imaging and numerical simulation would make it possible to better understand pelvic mobility and to study the potential defects related to the equilibrium of pelvic statics . The care can be adapted more precisely to the pathology in a specific way using a numerical FE model.…”

Section: Conclusion and Discussionmentioning

confidence: 99%

Three‐dimensional physics‐based registration of pelvic system using 2D dynamic magnetic resonance imaging slices

Courtecuisse

Jiang

Mayeur

et al. 2020

Strain

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This paper introduces a method for dynamic 3D registration of female pelvic organs using 2D dynamic magnetic-resonance images (MRIs). The aim is to provide a better knowledge and understanding of pathologies such as prolapsus or abnormal mobility of tissues. 2D dynamic MRI sequences are commonly used in nowadays clinical routines in order to evaluate the dynamic of organs, but due to the limited view, subjectivity related to human perception cannot be avoided in the diagnoses. A novel method for 2D/3D registration is proposed combining 3D finite element models with a priori knowledge of boundary conditions, in order to provide a 3D extrapolation of the dynamic of the organs observed in a single 2D MRI slice. The method is applied to the four main structures of the female pelvic floor (bladder, vagina, uterus and rectum), providing a full 3D visualisation of the organs' displacements. The methodology is evaluated with two patient-specific data sets of volunteers presenting no pelvic pathology, and a sensitivity study is performed using synthetic data. The resulting simulations provide an estimation of the dynamic 3D shape of the organs facilitating diagnosis compared with 2D sequences. Moreover, the method follows a protocol compatible with current clinical constraints presenting this way potential short term medical applications.

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“…Therefore, most of the key repairable structures of pelvic oor support are pubocervical fascia and uterosacral ligaments, which are located above levator ani muscle level, i.e., level I and II repair. A 3D digital model showed that pubocervical fascia is the most in uential structure in the onset of the median cystocele [12]. Accordingly, we attempted to reconstruct the pubocervical fascia and x it intraoperatively on the vaginal stump.…”

Section: Sacrospinous Ligament Xation (Sslf)mentioning

confidence: 99%

Medium-Term Outcomes of Laparoscopic Pubocervical Fascia Reconstruction and Sacrospinous Ligament Fixation for Pelvic Organ Prolapse

Zhu¹,

Xiao²,

Chen³

et al. 2020

Preprint

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Background: The aim of this study was to investigate the medium-term outcomes of laparoscopic pubocervical fascia reconstruction and sacrospinous ligament fixation with a posterior approach for severe pelvic organ prolapse (POP). Methods: A total of 129 patients with severe POP quantitation stage III-IV who underwent laparoscopic pubocervical fascia reconstruction and sacrospinous ligament fixation with a posterior approach at Sir Run Run Shaw Hospital College of Medicine, Zhejiang University, Hangzhou, China between September 2014 and December 2018 were enrolled in this study. One hundred twenty-four patients were followed up for at least 1 year. The results and complications were recorded. Data were retrospectively reviewed. Results: All the patients underwent laparoscopic pubocervical fascia reconstruction and sacrospinous ligament fixation with a posterior approach. The average follow-up time was 32.27±12.90 months. The objective cure rate for those who underwent hysterectomy was 91.7 % (100/109), and no patient experienced apical vaginal prolapse. The objective cure rate for those who retained uterus was 66.67% (10/15). Suture-related complications were recorded.Conclusions: Laparoscopic pubocervical fascia reconstruction and sacrospinous ligament fixation with the posterior approach is a safe, minimally invasive, and effective method for patients with severe POP. Long-term follow-up is required to confirm the clinical effects.

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Pathophysiological aspects of cystocele with a 3D finite elements model

Abstract: A 3D digital model enabled simulations of anatomic structures underlying cystocele to better understand cystocele pathophysiology. The model could be used to predict cystocele surgery results and personalising technique by preoperative simulation.

Cited by 13 publications

References 29 publications

Modelling of Soft Connective Tissues to Investigate Female Pelvic Floor Dysfunctions

Modelling of Soft Connective Tissues to Investigate Female Pelvic Floor Dysfunctions

Three‐dimensional physics‐based registration of pelvic system using 2D dynamic magnetic resonance imaging slices

Medium-Term Outcomes of Laparoscopic Pubocervical Fascia Reconstruction and Sacrospinous Ligament Fixation for Pelvic Organ Prolapse

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