Biomechanical Analyses of Posterior Vaginal Prolapse:MR Imaging and Computer Modeling Studies.

Pelvic Organ Prolapse;Posterior Vaginal Prolapse;Rectocele;3D;Finite Element Model;Biomechanical Model;Mechanical Engineering;Engineering;Mechanical Engineering

Luo, JiajiaHulbert, Gregory M. ;

University of Michigan

关键词: Pelvic Organ Prolapse;    Posterior Vaginal Prolapse;    Rectocele;    3D;    Finite Element Model;    Biomechanical Model;    Mechanical Engineering;    Engineering;    Mechanical Engineering;   

Others  :  https://deepblue.lib.umich.edu/bitstream/handle/2027.42/95942/jjluo_1.pdf?sequence=1&isAllowed=y

瑞士|英语

来源: The Illinois Digital Environment for Access to Learning and Scholarship

【 摘 要 】

Pelvic organ prolapse is an abnormal downward displacement and deformation ofthe female pelvic organs. Because it adversely affects quality of life, over 200,000operations are performed annually for prolapse in the U.S at a cost exceeding $1 billion.Approximately 87% of those procedures involve repair of a posterior vaginal prolapse, theetiology of which is a focus of this dissertation. But, because operative failure rates canapproach 30%, new insights are needed as to how and why a posterior vaginal prolapsedevelops in the first place so that treatment can be improved.We hypothesize that the occurrence, size and type of posterior vaginal prolapse isnot explained by failure of any single structure; rather it involves failure of connective tissuesupports at two and possibly up to as many as 20 anatomical sites, along with impairment ofthe levator ani muscle.Using in vivo magnetic resonance imaging we first visualized the detailed 3-D pelvicfloor anatomy of 84 healthy women. From these we then selected images from a pelvis ofaverage dimensions and used them to create a detailed three-dimensional interactivemodel of the female pelvic floor complete with 23 structures. We then developed amethod to measure and quantify the geometry of prolapse in forty 3-D magneticresonance image-based models. Two main structures relating to the development ofprolapse, fascia and apical vaginal supports, were then analyzed via two case-controlstudies. Finally, 2- and 3-D computer-based models were developed to identify thebiomechanical interactions which lead to prolapse: levator muscle and connective tissuefailure, and organ competition. These methodological approaches and computer modelsprovide new insights into the biomechanical mechanisms underlying the development ofposterior vaginal prolapse. Our hope is that they will lead to more effective surgicaltreatment strategies for this vexing condition.