Biomechanical Characterization of Sheep Vaginal Wall Tissue: A Potential Application in Human Pelvic Floor Disorders

2012 ◽  
Author(s):  
Sourav S. Patnaik ◽  
Benjamin Weed ◽  
Ali Borazjani ◽  
Robbin Bertucci ◽  
Mark Begonia ◽  
...  
Keyword(s):  
Levator Ani ◽  
Pelvic Organ ◽  
Vaginal Wall ◽  
Levator Ani Muscle ◽  
Social Psychological ◽  
Psychological Issues ◽  
Exact Etiology ◽  
History Of

Pelvic Organ Prolapse (POP) is a leading women’s health issue affecting a significant portion of the population and has been recently coined as a “silent epidemic”. POP leads to a considerable reduction in women’s quality of life and can cause chronic pelvic pain, sexual dysfunction, and social/psychological issues. The lifetime risk for having surgery for POP is approximately 11% with 200,000 POP procedures performed each year in USA, with an annual direct cost of over $1000 million. Exact etiology of POP is unclear, but it is understood that POP is multi-factorial in nature. Risk factors for POP include increasing age, obesity, multiple vaginal births, gravidity, history of hysterectomy, smoking, chronic cough conditions, frequent heavy lifting, and some genetic factors. POP results due to loss or damage of structural supports that support the pelvic organs (i.e. rectum, bowel, bladder, etc). Vaginal wall prolapse (anterior and posterior) is the most common presentation. This can result from weakening of the levator ani muscle and other connective tissue structures which not only control the mechanical function, but also help support neurological and anatomical function[1].

Prevalence of levator ani muscle avulsion and effect on quality of life in women with pelvic organ prolapse

2017 ◽  
Vol 29 (5) ◽  
pp. 729-733 ◽  
Author(s):  
Chun Hung Yu ◽  
Symphorosa Shing Chee Chan ◽  
Rachel Yau Kar Cheung ◽  
Tony Kwok Hung Chung
Keyword(s):  
Quality Of Life ◽  
Pelvic Organ Prolapse ◽  
Levator Ani ◽  
Pelvic Organ ◽  
Levator Ani Muscle ◽  
Levator Ani Muscle Avulsion

The Effect of Pubococcygeus Muscle Avulsion on the Anterior Vaginal Wall Support: A Biomechanical 3D Finite Element Modeling Study

2012 ◽  
Author(s):  
Luyun Chen ◽  
James A. Ashton-Miller ◽  
John O. L. DeLancey
Keyword(s):  
Finite Element ◽  
Levator Ani ◽  
Element Model ◽  
Pelvic Organ ◽  
Vaginal Wall ◽  
Anterior Vaginal Wall ◽  
Biomechanical Analysis ◽  
Pubic Bone ◽  
Levator Ani Muscle ◽  
3D Finite Element

Levator ani muscle defects are common in women after vaginal birth and have been associated with the development of pelvic organ prolapse (Kearney et al 2006, DeLancey et al 2007, and Dietz and Lanzarone 2005). Sometimes there is a loss of muscle substance but the overall shape of the muscle remains intact. In other instances, gross distortion of the muscle origin occurs (Huebner et al. 2008) presumably due to avulsion of muscle from the pubic bone. Theoretical biomechanical modeling work has showed that even with intact pubic origin, weakening of levator ani muscle leads to the development of cystocele (Chen et al, 2009). The biomechanical effects of avulsion of the pubic origin of the pubococcygeal muscle have not been fully explored. The objective of this study if to use a finite element model to perform a biomechanical analysis of how pubococcygeus muscle avulsion affects the descent of the anterior vaginal wall during a Valsalva.

scholarly journals Animal models for pelvic organ prolapse: systematic review

2021 ◽  
Author(s):  
Marina Gabriela M. C. Mori da Cunha ◽  
Katerina Mackova ◽  
Lucie Hajkova Hympanova ◽  
Maria Augusta T. Bortolini ◽  
Jan Deprest
Keyword(s):  
Pelvic Organ Prolapse ◽  
Animal Models ◽  
Vaginal Delivery ◽  
Structural Changes ◽  
Meta Analysis ◽  
Levator Ani ◽  
Complete Recovery ◽  
Pelvic Organ ◽  
Squirrel Monkeys ◽  
Levator Ani Muscle

Abstract Introduction and hypothesis We aimed to summarize the knowledge on the pathogenesis of pelvic organ prolapse (POP) generated in animal models. Methods We searched MEDLINE, Embase, Cochrane and the Web of Science to establish what animal models are used in the study of suggested risk factors for the development of POP, including pregnancy, labor, delivery, parity, aging and menopause. Lack of methodologic uniformity precluded meta-analysis; hence, results are presented as a narrative review. Results A total of 7426 studies were identified, of which 51 were included in the analysis. Pregnancy has a measurable and consistent effect across species. In rats, simulated vaginal delivery induces structural changes in the pelvic floor, without complete recovery of the vaginal muscular layer and its microvasculature, though it does not induce POP. In sheep, first vaginal delivery has a measurable effect on vaginal compliance; measured effects of additional deliveries are inconsistent. Squirrel monkeys can develop POP. Denervation of their levator ani muscle facilitates this process in animals that delivered vaginally. The models used do not develop spontaneous menopause, so it is induced by ovariectomy. Effects of menopause depend on the age at ovariectomy and the interval to measurement. In several species menopause is associated with an increase in collagen content in the longer term. In rodents there were no measurable effects of age apart of elastin changes. We found no usable data for other species. Conclusion In several species there are measurable effects of pregnancy, delivery and iatrogenic menopause. Squirrel monkeys can develop spontaneous prolapse.

scholarly journals Pregnancy after tension-free vaginal mesh (anterior Prolift) and concomitant tension-free vaginal tape-obturator procedure

2011 ◽  
Vol 25 (1) ◽  
pp. 17
Author(s):  
Xiao Luo ◽  
Li Xiao Wan ◽  
Hong Shen ◽  
Yin Xiu Xia ◽  
Chao Han Zhang ◽  
...  
Keyword(s):  
Caesarean Section ◽  
Young Patients ◽  
Pelvic Organ ◽  
Vaginal Wall ◽  
Vaginal Mesh ◽  
Pelvic Floor Reconstruction ◽  
Tension Free ◽  
Tension Free Vaginal Tape ◽  
History Of ◽  
Vaginal Tape Obturator

<em>Objective</em>. Treatment of anterior vaginal wall prolapse and stress urinary incontinence (SUI) with transobturator tension-free vaginal mesh (anterior Prolift) and concomitant tension-free vaginal tape-obturator (TVT-O) has been proved feasible, safe and effective. However, there is little known about the influence of pregnancy on women who have had such procedures before pregnancy. <em>Design and methods.</em> A 32-year-old woman (gravid 1, para 1) with two years history of SUI and nine months history of pelvic organ prolapse (POP) was treated with transobturator tension-free vaginal mesh (anterior Prolift) and concomitant TVT-O. Her recovery was excellent, and she was pregnant eight months after the operation. <em>Results</em>. The patient went through her pregnancy smoothly with no special discomfort and successfully delivered an infant via caesarean section without recurrence of POP and SUI. Her last visit to our clinic about 14 months after caesarean section revealed that the anterior Prolift mesh and TVT-O mesh still remained intact and the position of the vaginal fornix, anterior and posterior walls and uterus also remained normal. <em>Conclusions</em>: Pelvic floor reconstruction with vaginal mesh (Prolift) may have positive significance for young patients who desire uterine preservation for future pregnancies. However, further studies are warranted to determine whether it can be used in pregnant women or women planning future pregnancies.

Inter-Observer Variability of Vaginal Wall Segmentation From MRI: A Statistical Shape Analysis Approach

2015 ◽  
Author(s):  
Deanna C. Easley ◽  
Prahlad G. Menon ◽  
Pamela A. Moalli ◽  
Steven D. Abramowitch
Keyword(s):  
Shape Matching ◽  
Pelvic Floor Disorders ◽  
Pelvic Organ ◽  
Vaginal Wall ◽  
Resonance Imaging ◽  
Inter Observer Variability ◽  
Statistical Shape ◽  
Mri Scans ◽  
Magnetic Resonance Imaging Mri

Pelvic floor disorders such as Pelvic Organ Prolapse (POP) negatively impact the health and quality of life of millions of women worldwide. POP is characterized by the descent of the pelvic organs into the vagina due to compromised connective tissue support, resulting in discomfort and urinary/fecal incontinence. Magnetic Resonance Imaging (MRI) has been used to aid in the quantification of these anatomical changes, however the inter- and intra-observer repeatability necessary to make reliable conclusions about changes in anatomical positioning is questioned using current methods. The aim of this study was to quantify the degree of variability produced from inter-observer manual tracings of the vagina from MRI scans using a statistical shape matching approach.

Levator ani subtended volume: a novel parameter to evaluate levator ani muscle laxity in pelvic organ prolapse

2012 ◽  
Vol 206 (3) ◽  
pp. 244.e1-244.e9 ◽  
Author(s):  
Antonio Antunes Rodrigues ◽  
Renee Bassaly ◽  
Mona McCullough ◽  
H. Leigh Terwilliger ◽  
Stuart Hart ◽  
...  
Keyword(s):  
Pelvic Organ Prolapse ◽  
Levator Ani ◽  
Pelvic Organ ◽  
Levator Ani Muscle

scholarly journals Correlation of levator ani muscle strength measurement between Modified Oxford Grading Scale and perineometer on pelvic organ prolapse patient

2021 ◽  
Vol 33 (1) ◽  
Author(s):  
Fernandi Moegni ◽  
Ingrid Felicia Ocsilia Wengkang
Keyword(s):  
Pelvic Organ Prolapse ◽  
Muscle Strength ◽  
Levator Ani ◽  
Pelvic Organ ◽  
Levator Ani Muscle ◽  
Moderate Pressure ◽  
Cross Sectional ◽  
Digital Palpation ◽  
Grading Scale ◽  
Spearman Test

Pelvic Organ Prolapse (POP) is a debilitating condition affecting about half of all women aged of more than 60 years globally. Reduced levator ani muscle strength in POP is associated with worse symptoms and prognosis. Measurement of levator ani muscle strength can be done with several tools such as perineometer and digital palpation. However, there is currently no study regarding conformity between tests. The aim of this study is to determine the correlation between tests in POP patients. An analytic observational study using cross sectional design was done to determine conformity between perineometer and digital examination using Modified Oxford Grading Scale (MOS) in Dr Cipto Mangunkusumo National General Hospital, Indonesia during the period of July, 2018 to June, 2020. Correlation between tests was determined using Spearman test. Cut-off of perineometer reading for each MOS score was also determined. A total of 110 subjects examined with both perineometer and digital palpation were recruited to the study. Positive correlation was observed between perineometer reading and Modified Oxford Grading Scale (r = 0.790, p < 0.001). According to the result, values between 0.01 – 9.64 cmH2O correspond to very weak pressure (MOS 1); 9.65 – 22.49 cmH2O represent weak pressure (MOS 2); 22.5 – 35.24 cmH2O represent moderate pressure (MOS 3); ≥ 35.25 cmH2O represent good pressure (MOS 4). There was a strong correlation between MOS and perineometer result for measuring levator ani strength in POP patients.

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