1
|
Lallemant M, Shimojyo AA, Mayeur O, Ramanah R, Rubod C, Kerbage Y, Cosson M. Mobility analysis of a posterior sacrospinous fixation using a finite element model of the pelvic system. PLoS One 2024; 19:e0299012. [PMID: 38512958 PMCID: PMC10956756 DOI: 10.1371/journal.pone.0299012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 02/04/2024] [Indexed: 03/23/2024] Open
Abstract
INTRODUCTION AND HYPOTHESIS In order to improve the knowledge POP physiopathology and POP repair, a generic biomechanical model of the female pelvic system has been developed. In the literature, no study has currently evaluated apical prolapse repair by posterior sacrospinous ligament fixation using a generic model nor a patient-specific model that personalize the management of POP and predict surgical outcomes based on the patient's pre-operative Magnetic Resonance Imaging. The aim of our study was to analyze the influence of a right and/or left sacrospinous ligament fixation and the distance between the anchorage area and the ischial spine on the pelvic organ mobility using a generic and a patient-specific Finite Element model (FEM) of the female pelvic system during posterior sacrospinous ligament fixation (SSF). METHODS Firstly, we used a generic 3D FEM of the female pelvic system previously made by our team that allowed us to simulate the mobility of the pelvic system. To create a patient-specific 3D FEM of the female pelvic system, we used a preoperative dynamic pelvic MRI of a 68 years old woman with a symptomatic stage III apical prolapse and cystocele. With these 2 models, a SSF was simulated. A right and/or left SSF and different distances between the anchorage area and the ischial spine (1 cm, 2 cm and 3 cm.) were compared. Outcomes measures were the pelvic organ displacement using the pubococcygeal line during maximal strain: Ba point for the most posterior and inferior aspect of the bladder base, C point the cervix's or the vaginal apex and Bp point for the anterior aspect of the anorectal junction. RESULTS Overall, pelvic organ mobility decreased regardless of surgical technique and model. According to the generic model, C point was displaced by 14.1 mm and 11.5 mm, Ba point by 12.7 mm, and 12 mm and Bp point by 10.6 mm and 9.9 mm after left and bilateral posterior SSF, respectively. C point was displaced by 15.4 mm and 11.6 mm and Ba point by 12.5 mm and 13.1mm when the suture on the sacrospinous ligament was performed at 1 cm and 3 cm from the ischial spine respectively (bilateral posterior SSF configuration). According to the patient-specific model, the displacement of Ba point could not be analyzed because of a significative and asymmetric organ displacement of the bladder. C point was displaced by 4.74 mm and 2.12 mm, and Bp point by 5.30 mm and 3.24 mm after left and bilateral posterior SSF respectively. C point was displaced by 4.80 mm and 4.85 mm and Bp point by 5.35 mm and 5.38 mm when the suture on the left sacrospinous ligament was performed at 1 cm and 3 cm from the ischial spine, respectively. CONCLUSION According to the generic model from our study, the apex appeared to be less mobile in bilateral SSF. The anchorage area on the sacrospinous ligament seems to have little effect on the pelvic organ mobilities. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04551859.
Collapse
Affiliation(s)
- Marine Lallemant
- Service de Gynécologie Obstétrique, Pôle Mère-Femme, Centre Hospitalier Universitaire Jean Minjoz, Besançon, France
- Université Lille, CNRS, Centrale Lille, UMR 9013—LaMcube—Laboratoire de Mécanique, Multiphysique, Multiéchelle, F-59000, Lille, France
| | - Andres Arteaga Shimojyo
- Université Lille, CNRS, Centrale Lille, UMR 9013—LaMcube—Laboratoire de Mécanique, Multiphysique, Multiéchelle, F-59000, Lille, France
| | - Olivier Mayeur
- Université Lille, CNRS, Centrale Lille, UMR 9013—LaMcube—Laboratoire de Mécanique, Multiphysique, Multiéchelle, F-59000, Lille, France
| | - Rajeev Ramanah
- Service de Gynécologie Obstétrique, Pôle Mère-Femme, Centre Hospitalier Universitaire Jean Minjoz, Besançon, France
- Laboratoire de Nanomédecine, Imagerie et Thérapeutiques, INSERM E4 4662, Université de Franche-Comté, Besançon, France
| | - Chrystèle Rubod
- Université Lille, CNRS, Centrale Lille, UMR 9013—LaMcube—Laboratoire de Mécanique, Multiphysique, Multiéchelle, F-59000, Lille, France
- CHU Lille, Service de Chirurgie Gynécologique, F-59000, Lille, France
- Faculté de médecine, Université Lille Nord de France, F-59000, Lille, France
| | - Yohan Kerbage
- Université Lille, CNRS, Centrale Lille, UMR 9013—LaMcube—Laboratoire de Mécanique, Multiphysique, Multiéchelle, F-59000, Lille, France
- CHU Lille, Service de Chirurgie Gynécologique, F-59000, Lille, France
- Faculté de médecine, Université Lille Nord de France, F-59000, Lille, France
| | - Michel Cosson
- Université Lille, CNRS, Centrale Lille, UMR 9013—LaMcube—Laboratoire de Mécanique, Multiphysique, Multiéchelle, F-59000, Lille, France
- CHU Lille, Service de Chirurgie Gynécologique, F-59000, Lille, France
- Faculté de médecine, Université Lille Nord de France, F-59000, Lille, France
| |
Collapse
|
2
|
Zarrinchang P, Ashrafizaadeh M, Jamshidi N. Simulation of the female pelvic mobility and vesical pressure changes employing fluid-structure interaction method. Int Urogynecol J 2023; 34:571-580. [PMID: 36169682 DOI: 10.1007/s00192-022-05362-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 09/05/2022] [Indexed: 01/26/2023]
Abstract
INTRODUCTION AND HYPOTHESIS This study aims to develop a fluid-structural interaction (FSI) method to pinpoint the effects of pressure changes inside the bladder and their impact on the supporting structure and the urethra mobility. METHODS A physiological model of the nulliparous female pelvis, including the organs, supportive structures, and urine, was developed based on magnetic resonance images. Soft tissues with nonlinear hyperelastic material characteristics were modeled. The Navier-Stokes equations governing the fluid flow within the computational domain (urine) were solved. The urine and soft tissue interactions were simulated by the FSI method. The vesical pressure and its impact on the urethral mobility and supportive structures were investigated during the Valsalva maneuver. Moreover, the simulation results were validated by comparing with a urodynamic test and other research. RESULTS The results demonstrated that the vesical pressure simulated by the FSI method could predict the nonlinear behavior of the urodynamic test pressure. The urethra retropubic bladder neck and the bladder neck-pubic bone angle changed 58.92% and -55.76%, respectively. The retropubic urethral length distance changed by -48.74%. The error compared to the statistical results of other research is < 5%. CONCLUSIONS The total deformation and mobility of the urethra predicted by the FSI model were consistent with clinical observations in a subject. The urethra supports dependence on the tissues' mechanical properties, interaction between the tissues, and effect of urine fluid inside the bladder. This simulation effectively depicts the patterns of urethra mobility, which provides a better understanding of the behavior of the pelvic floor.
Collapse
Affiliation(s)
- Pouya Zarrinchang
- Mechanical Engineering group, Pardis College, Isfahan University of Technology, Isfahan, 84156-83111, Iran
| | - Mahmud Ashrafizaadeh
- Department of Mechanical Engineering, Isfahan University of Technology, Isfahan, 84156-83111, Iran.
| | - Nima Jamshidi
- Department of Biomedical Engineering, Faculty of Engineering, University of Isfahan, Isfahan, Iran
| |
Collapse
|
3
|
Diallo MN, Mayeur O, Lecomte-Grosbras P, Patrouix L, Witz JF, Lesaffre F, Rubod C, Cosson M, Brieu M. Simulation of the mobility of the pelvic system: influence of fascia between organs. Comput Methods Biomech Biomed Engin 2021; 25:1073-1087. [PMID: 34783611 DOI: 10.1080/10255842.2021.2001460] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The mobility of pelvic organs is the result of an equilibrium called Pelvic Static characterizing the balance between the properties and geometries of organs, suspensions and support system. Any imbalance in this complex system can cause of pelvic static disorder. Genital prolapse is a common hypermobility pathology which is complex, multi factorial and its surgical management has high rate of complications. The use of 3 D numerical models and simulation enables the role of the various suspension structures to be objectively studied and quantified. Fascias are connective tissues located between organs. Although their role are described as important in various descriptions of pelvic statics, their influence and role has never been quantitatively objectified. This article presents a refine Finite Element (FE) model for a better understanding of biomechanical contribution of inter-organ fascia. The model is built from MRI images of a young volunteer, the mechanical properties derived from literature data to take into account the age of the patient and new experimental results have enabled an order of magnitude of the mechanical properties of the fascias to be defined. The FE results allows to quantify the biomechanical role of the fascia on pelvic mobility quantified by an analysis of dynamic MRI images and a local mapping of the gap between calculated and measured displacements. This improved numerical model integrating the fascias makes it possible to describe pelvic mobilities with a gap of 1 mm between numerical simulations and measurements, whereas without taking them into account this gap locally reaches 20 mm.
Collapse
Affiliation(s)
- Mouhamadou Nassirou Diallo
- CNRS, Centrale Lille, UMR 9013 - LaMcube - Laboratoire de Mécanique, Multiphysique, Multiéchelle, University of Lille, Lille, France
| | - Olivier Mayeur
- CNRS, Centrale Lille, UMR 9013 - LaMcube - Laboratoire de Mécanique, Multiphysique, Multiéchelle, University of Lille, Lille, France
| | - Pauline Lecomte-Grosbras
- CNRS, Centrale Lille, UMR 9013 - LaMcube - Laboratoire de Mécanique, Multiphysique, Multiéchelle, University of Lille, Lille, France
| | - Laurent Patrouix
- CNRS, Centrale Lille, UMR 9013 - LaMcube - Laboratoire de Mécanique, Multiphysique, Multiéchelle, University of Lille, Lille, France
| | - Jean François Witz
- CNRS, Centrale Lille, UMR 9013 - LaMcube - Laboratoire de Mécanique, Multiphysique, Multiéchelle, University of Lille, Lille, France
| | - François Lesaffre
- CNRS, Centrale Lille, UMR 9013 - LaMcube - Laboratoire de Mécanique, Multiphysique, Multiéchelle, University of Lille, Lille, France
| | - Chrystle Rubod
- CNRS, Centrale Lille, UMR 9013 - LaMcube - Laboratoire de Mécanique, Multiphysique, Multiéchelle, University of Lille, Lille, France.,Service de chirurgie gynécologique - CHU Lille, Lille, France
| | - Michel Cosson
- CNRS, Centrale Lille, UMR 9013 - LaMcube - Laboratoire de Mécanique, Multiphysique, Multiéchelle, University of Lille, Lille, France.,Service de chirurgie gynécologique - CHU Lille, Lille, France
| | - Mathias Brieu
- CNRS, Centrale Lille, UMR 9013 - LaMcube - Laboratoire de Mécanique, Multiphysique, Multiéchelle, University of Lille, Lille, France.,Department of Mechanical Engineering, College Engineering, Computer Science and Technology, California State University, Los Angeles, Long Angeles, CA, USA
| |
Collapse
|
4
|
Biomechanical trade-offs in the pelvic floor constrain the evolution of the human birth canal. Proc Natl Acad Sci U S A 2021; 118:2022159118. [PMID: 33853947 DOI: 10.1073/pnas.2022159118] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Compared with most other primates, humans are characterized by a tight fit between the maternal birth canal and the fetal head, leading to a relatively high risk of neonatal and maternal mortality and morbidities. Obstetric selection is thought to favor a spacious birth canal, whereas the source for opposing selection is frequently assumed to relate to bipedal locomotion. Another, yet underinvestigated, hypothesis is that a more expansive birth canal suspends the soft tissue of the pelvic floor across a larger area, which is disadvantageous for continence and support of the weight of the inner organs and fetus. To test this "pelvic floor hypothesis," we generated a finite element model of the human female pelvic floor and varied its radial size and thickness while keeping all else constant. This allowed us to study the effect of pelvic geometry on pelvic floor deflection (i.e., the amount of bending from the original position) and tissue stresses and stretches. Deflection grew disproportionately fast with increasing radial size, and stresses and stretches also increased. By contrast, an increase in thickness increased pelvic floor stiffness (i.e., the resistance to deformation), which reduced deflection but was unable to fully compensate for the effect of increasing radial size. Moreover, larger thicknesses increase the intra-abdominal pressure necessary for childbirth. Our results support the pelvic floor hypothesis and evince functional trade-offs affecting not only the size of the birth canal but also the thickness and stiffness of the pelvic floor.
Collapse
|
5
|
Cechova H, Kalis V, Havelkova L, Rusavy Z, Fiala P, Rybarova M, Hyncik L, Krofta L, Ismail KM. Finite element modeling of maximum stress in pelvic floor structures during the head expulsion (FINESSE) study. Int Urogynecol J 2021; 32:1997-2003. [PMID: 33797593 DOI: 10.1007/s00192-021-04769-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 03/14/2021] [Indexed: 12/12/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Several studies have assessed birth-related deformations of the levator ani muscle (LAM) and perineum on models that depicted these elements in isolation. The main aim of this study was to develop a complex female pelvic floor computational model using the finite element method to evaluate points and timing of maximum stress at the LAM and perineum in relation to the birth process. METHODS A three-dimensional computational model of the female pelvic floor was created and used to simulate vaginal birth based on data from previously described real-life MRI scans. We developed three models: model A (LAM without perineum); model B (perineum without LAM); model C (a combined model with both structures). RESULTS The maximum stress in the LAM was achieved when the vertex was 9 cm below the ischial spines and measured 37.3 MPa in model A and 88.7 MPa in model C. The maximum stress in the perineum occurred at the time of distension by the suboocipito-frontal diameter and reached 86.7 MPa and 119.6 MPa in models B and C, respectively, while the stress in the posterior fourchette caused by the suboccipito-bregmatic diameter measured 36.9 MPa for model B and 39.8 MPa for model C. CONCLUSIONS Including perineal structures in a computational birth model simulation affects the level of stress at the LAM. The maximum stress at the LAM and perineum seems to occur when the head is lower than previously anticipated.
Collapse
Affiliation(s)
- Hana Cechova
- New Technologies - Research Centre, University of West Bohemia, Pilsen, Czech Republic
| | - Vladimir Kalis
- Department of Obstetrics and Gynecology, University Hospital, Pilsen, Czech Republic.,Department of Obstetrics and Gynecology, Faculty of Medicine, Charles University, alej Svobody 76, 304 60, Pilsen, Czech Republic.,Biomedical Center, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic
| | - Linda Havelkova
- New Technologies - Research Centre, University of West Bohemia, Pilsen, Czech Republic
| | - Zdenek Rusavy
- Department of Obstetrics and Gynecology, University Hospital, Pilsen, Czech Republic.,Department of Obstetrics and Gynecology, Faculty of Medicine, Charles University, alej Svobody 76, 304 60, Pilsen, Czech Republic.,Biomedical Center, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic
| | - Pavel Fiala
- Department of Anatomy, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic
| | - Martina Rybarova
- Department of Anatomy, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic
| | - Ludek Hyncik
- New Technologies - Research Centre, University of West Bohemia, Pilsen, Czech Republic
| | - Ladislav Krofta
- Institute for the Care of Mother and Child, Podolské nábřeží 157, 147 00, Prague, Czech Republic
| | - Khaled M Ismail
- Department of Obstetrics and Gynecology, Faculty of Medicine, Charles University, alej Svobody 76, 304 60, Pilsen, Czech Republic. .,Biomedical Center, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic.
| |
Collapse
|
6
|
Wu Y, Hikspoors JPJM, Mommen G, Dabhoiwala NF, Hu X, Tan LW, Zhang SX, Lamers WH. Interactive three-dimensional teaching models of the female and male pelvic floor. Clin Anat 2019; 33:275-285. [PMID: 31639237 PMCID: PMC7027585 DOI: 10.1002/ca.23508] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Revised: 09/22/2019] [Accepted: 10/15/2019] [Indexed: 02/02/2023]
Abstract
Controversies regarding structure and function of the pelvic floor persist because of its poor accessibility and complex anatomical architecture. Most data are based on dissection. This "surgical" approach requires profound prior knowledge, because applying the scalpel precludes a "second look." The "sectional" approach does not entail these limitations, but requires segmentation of structures and three-dimensional reconstruction. This approach has produced several "Visible Human Projects." We dealt with limited spatial resolution and difficult-to-segment structures by proceeding from clear-cut to more fuzzy boundaries and comparing segmentation between investigators. We observed that the bicipital levator ani muscle consisted of pubovisceral and puborectal portions; that the pubovisceral muscle formed, together with rectococcygeal and rectoperineal muscles, a rectal diaphragm; that the external anal sphincter consisted of its subcutaneous portion and the puborectal muscle only; that the striated urethral sphincter had three parts, of which the middle (urethral compressor) was best developed in females and the circular lower ("membranous") best in males; that the rectourethral muscle, an anterior extension of the rectal longitudinal smooth muscle, developed a fibrous node in its center (perineal body); that the perineal body was much better developed in females than males, so that the rectourethral subdivision into posterior rectoperineal and anterior deep perineal muscles was more obvious in females; that the superficial transverse perineal muscle attached to the fibrous septa of the ischioanal fat; and that the uterosacral ligaments and mesorectal fascia colocalized. To facilitate comprehension of the modified topography we provide interactive 3D-PDFs that are freely available for teaching purposes. Clin. Anat. 33:275-285, 2020. © 2019 Wiley Periodicals, Inc.
Collapse
Affiliation(s)
- Yi Wu
- Tytgat Institute for Liver and Intestinal Research, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.,Institute of Digital Medicine, College of Biomedical Engineering and Imaging Medicine, Army Military Medical University, Chongqing, China
| | - Jill P J M Hikspoors
- Department of Anatomy & Embryology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Greet Mommen
- Department of Anatomy & Embryology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Noshir F Dabhoiwala
- Tytgat Institute for Liver and Intestinal Research, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Xin Hu
- Institute of Digital Medicine, College of Biomedical Engineering and Imaging Medicine, Army Military Medical University, Chongqing, China
| | - Li-Wen Tan
- Institute of Digital Medicine, College of Biomedical Engineering and Imaging Medicine, Army Military Medical University, Chongqing, China
| | - Shao-Xiang Zhang
- Institute of Digital Medicine, College of Biomedical Engineering and Imaging Medicine, Army Military Medical University, Chongqing, China
| | - Wouter H Lamers
- Tytgat Institute for Liver and Intestinal Research, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.,Department of Anatomy & Embryology, Maastricht University Medical Center, Maastricht, The Netherlands
| |
Collapse
|
7
|
Gatellier MA, Dit Gautier EJ, Mayeur O, Brieu M, Cosson M, Rubod C. Complete 3 dimensional reconstruction of parturient pelvic floor. J Gynecol Obstet Hum Reprod 2019; 49:101635. [PMID: 31499277 DOI: 10.1016/j.jogoh.2019.101635] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 08/05/2019] [Accepted: 09/05/2019] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The women pelvic floor is a complex system, which seems to endure several modifications during pregnancy and childbirth. Our primary purpose was to build an extensive 3 dimensional (3D) numerical anatomical model of the women pelvic floor. METHODS First, the role and the location of each organ, muscle, or ligament, were identified through an extensive literature review. Then, different entities were selected because of their visibility and importance in the pelvic floor. Each entity was identified using anatomical knowledge, and outlined on 2 dimensional (2D) MRI images, that were carried out on 4 pregnant women, using sequences T1, T2 and proton density weighted, through AVIZO program. The overlay of these 2D outlines produced a 3D geometrical reconstruction, which was then reworked with the program CATIA to obtain a usable geometric model. RESULTS We identified and integrated 15 anatomical structures to the geometrical model, including organs, ligament and muscles from the pelvis and perineum. This geometrical model allowed us to obtain a visual interactive representation with 3D images. These different steps resulted in the creation of a complete numerical model of the female pelvic floor, which might be used in Finite Element simulation. CONCLUSION A new complete and accurate 3D numerical anatomical model of the women pelvic floor was elaborated. It presents simultaneously analytical prospects, through the observation of the strains and deformations that are imposed on the different structures, and educational prospects, through the detailed visual representation of several situations.
Collapse
Affiliation(s)
- Marie-Anne Gatellier
- University of Lille, Faculty of Medicine, F-59000, Lille, France; Gynecologic Surgery Unit, Lille University Hospital Center, Hopital Jeanne de Flandre, Rue Eugene Avinee, F-59000, Lille, France.
| | - Estelle Jean Dit Gautier
- University of Lille, Faculty of Medicine, F-59000, Lille, France; Gynecologic Surgery Unit, Lille University Hospital Center, Hopital Jeanne de Flandre, Rue Eugene Avinee, F-59000, Lille, France; CNRS - FRE 2016 - LaMcube, Laboratoire de mécanique multiphysique multiéchelle, Ecole Centrale de Lille, Cite scientifique, F-59650, Villeneuve d'Ascq, France
| | - Olivier Mayeur
- CNRS - FRE 2016 - LaMcube, Laboratoire de mécanique multiphysique multiéchelle, Ecole Centrale de Lille, Cite scientifique, F-59650, Villeneuve d'Ascq, France
| | - Mathias Brieu
- CNRS - FRE 2016 - LaMcube, Laboratoire de mécanique multiphysique multiéchelle, Ecole Centrale de Lille, Cite scientifique, F-59650, Villeneuve d'Ascq, France
| | - Michel Cosson
- University of Lille, Faculty of Medicine, F-59000, Lille, France; Gynecologic Surgery Unit, Lille University Hospital Center, Hopital Jeanne de Flandre, Rue Eugene Avinee, F-59000, Lille, France; CNRS - FRE 2016 - LaMcube, Laboratoire de mécanique multiphysique multiéchelle, Ecole Centrale de Lille, Cite scientifique, F-59650, Villeneuve d'Ascq, France
| | - Chrystele Rubod
- University of Lille, Faculty of Medicine, F-59000, Lille, France; Gynecologic Surgery Unit, Lille University Hospital Center, Hopital Jeanne de Flandre, Rue Eugene Avinee, F-59000, Lille, France; CNRS - FRE 2016 - LaMcube, Laboratoire de mécanique multiphysique multiéchelle, Ecole Centrale de Lille, Cite scientifique, F-59650, Villeneuve d'Ascq, France
| |
Collapse
|
8
|
Giraudet G, Patrouix L, Fontaine C, Demondion X, Cosson M, Rubod C. Three dimensional model of the female perineum and pelvic floor muscles. Eur J Obstet Gynecol Reprod Biol 2018; 226:1-6. [DOI: 10.1016/j.ejogrb.2018.05.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 05/01/2018] [Accepted: 05/10/2018] [Indexed: 11/26/2022]
|
9
|
Nekooeimehr I, Lai-Yuen S, Bao P, Weitzenfeld A, Hart S. Automated contour tracking and trajectory classification of pelvic organs on dynamic MRI. J Med Imaging (Bellingham) 2018; 5:014008. [PMID: 29651450 DOI: 10.1117/1.jmi.5.1.014008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Accepted: 03/12/2018] [Indexed: 11/14/2022] Open
Abstract
A method is presented to automatically track and segment pelvic organs on dynamic magnetic resonance imaging (MRI) followed by multiple-object trajectory classification to improve understanding of pelvic organ prolapse (POP). POP is a major health problem in women where pelvic floor organs fall from their normal position and bulge into the vagina. Dynamic MRI is presently used to analyze the organs' movements, providing complementary support for clinical examination. However, there is currently no automated or quantitative approach to measure the movement of the pelvic organs and their correlation with the severity of prolapse. In the proposed method, organs are first tracked and segmented using particle filters and [Formula: see text]-means clustering with prior information. Then, the trajectories of the pelvic organs are modeled using a coupled switched hidden Markov model to classify the severity of POP. Results demonstrate that the presented method can automatically track and segment pelvic organs with a Dice similarity index above 78% and Hausdorff distance of [Formula: see text] for 94 tested cases while demonstrating correlation between organ movement and POP. This work aims to enable automatic tracking and analysis of multiple deformable structures from images to improve understanding of medical disorders.
Collapse
Affiliation(s)
| | - Susana Lai-Yuen
- University of South Florida, Department of Industrial and Management Systems Engineering, Tampa, Florida, United States
| | - Paul Bao
- University of South Florida, Department of Computer Science and Engineering, Tampa, Florida, United States
| | - Alfredo Weitzenfeld
- University of South Florida, Department of Computer Science and Engineering, Tampa, Florida, United States
| | - Stuart Hart
- University of South Florida, Department of Obstetrics and Gynecology, Tampa, Florida, United States.,Medtronic, Tampa, Florida, United States
| |
Collapse
|
10
|
Jean Dit Gautier E, Mayeur O, Lepage J, Brieu M, Cosson M, Rubod C. Pregnancy impact on uterosacral ligament and pelvic muscles using a 3D numerical and finite element model: preliminary results. Int Urogynecol J 2017; 29:425-430. [DOI: 10.1007/s00192-017-3520-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 11/08/2017] [Indexed: 12/28/2022]
|
11
|
Wu Y, Dabhoiwala NF, Hagoort J, Tan L, Zhang S, Lamers WH. Architectural differences in the anterior and middle compartments of the pelvic floor of young-adult and postmenopausal females. J Anat 2017; 230:651-663. [PMID: 28299781 PMCID: PMC5382597 DOI: 10.1111/joa.12598] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2017] [Indexed: 11/26/2022] Open
Abstract
The pelvic floor guards the passage of the pelvic organs to the exterior. The near-epidemic prevalence of incontinence in women continues to generate interest in the functional anatomy of the pelvic floor. However, due to its complex architecture and poor accessibility, the classical 'dissectional' approach has been unable to come up with a satisfactory description, so that many aspects of its anatomy continue to raise debate. For this reason, we opted for a 'sectional' approach, using the Chinese Visible Human project (four females, 21-35 years) and the Visible Human Project (USA; one female, 59 years) datasets to investigate age-related changes in the architecture of the anterior and middle compartments of the pelvic floor. The puborectal component of the levator ani muscle defined the levator hiatus boundary. The urethral sphincter complex consisted of a circular proximal portion (urethral sphincter proper), a sling that passed on the vaginal wall laterally to attach to the puborectal muscle (urethral compressor), and a circular portion that surrounded the distal urethra and vagina (urethrovaginal sphincter). The exclusive attachment of the urethral sphincter to soft tissues implies dependence on pelvic-floor integrity for optimal function. The vagina was circular at the introitus and gradually flattened between bladder and rectum. Well-developed fibrous tissue connected the inferior vaginal wall with urethra, rectum and pelvic floor. With eight-muscle insertions, the perineal body was a strong, irregular fibrous node that guarded the levator hiatus. Only loose areolar tissue comprising a remarkably well developed venous plexus connecting the middle and superior parts of the vagina with the lateral pelvic wall. The posterolateral boundary of the putative cardinal and sacrouterine ligaments coincided with the adventitia surrounding the mesorectum. The major difference between the young-adult and postmenopausal pelvic floor was the expansion of fat in between the components of the pelvic floor. We hypothesize that accumulation of pelvic fat compromises pelvic-floor cohesion, because the pre-pubertal pelvis contains very little fibrous and adipose tissue, and fat is an excellent lubricant.
Collapse
Affiliation(s)
- Yi Wu
- Tytgat Institute for Liver and Intestinal ResearchAcademic Medical CenterUniversity of AmsterdamAmsterdamThe Netherlands
- Institute of Computing MedicineBiomedical Engineering CollegeThird Military Medical UniversityChongqingChina
| | - Noshir F. Dabhoiwala
- Tytgat Institute for Liver and Intestinal ResearchAcademic Medical CenterUniversity of AmsterdamAmsterdamThe Netherlands
| | - Jaco Hagoort
- Department of Anatomy & EmbryologyAcademic Medical CenterUniversity of AmsterdamAmsterdamThe Netherlands
| | - Li‐Wen Tan
- Institute of Computing MedicineBiomedical Engineering CollegeThird Military Medical UniversityChongqingChina
| | - Shao‐Xiang Zhang
- Institute of Computing MedicineBiomedical Engineering CollegeThird Military Medical UniversityChongqingChina
| | - Wouter H. Lamers
- Tytgat Institute for Liver and Intestinal ResearchAcademic Medical CenterUniversity of AmsterdamAmsterdamThe Netherlands
| |
Collapse
|
12
|
Nekooeimehr I, Lai-Yuen S, Bao P, Weitzenfeld A, Hart S. Automated tracking, segmentation and trajectory classification of pelvic organs on dynamic MRI. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2016; 2016:2403-2406. [PMID: 28268809 DOI: 10.1109/embc.2016.7591214] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Pelvic organ prolapse is a major health problem in women where pelvic floor organs (bladder, uterus, small bowel, and rectum) fall from their normal position and bulge into the vagina. Dynamic Magnetic Resonance Imaging (DMRI) is presently used to analyze the organs' movements from rest to maximum strain providing complementary support for diagnosis. However, there is currently no automated or quantitative approach to measure the movement of the pelvic organs and their correlation with the severity of prolapse. In this paper, a two-stage method is presented to automatically track and segment pelvic organs on DMRI followed by a multiple-object trajectory classification method to improve the diagnosis of pelvic organ prolapse. Organs are first tracked using particle filters and K-means clustering with prior information. Then, they are segmented using the convex hull of the cluster of particles. Finally, the trajectories of the pelvic organs are modeled using a new Coupled Switched Hidden Markov Model (CSHMM) to classify the severity of pelvic organ prolapse. The tracking and segmentation results are validated using Dice Similarity Index (DSI) whereas the classification results are compared with two manual clinical measurements. Results demonstrate that the presented method is able to automatically track and segment pelvic organs with a DSI above 82% for 26 out of 46 cases and DSI above 75% for all 46 tested cases. The accuracy of the trajectory classification model is also better than current manual measurements.
Collapse
|
13
|
Mobility and stress analysis of different surgical simulations during a sacral colpopexy, using a finite element model of the pelvic system. Int Urogynecol J 2016; 27:951-7. [PMID: 26755057 DOI: 10.1007/s00192-015-2917-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Accepted: 12/02/2015] [Indexed: 10/22/2022]
Abstract
INTRODUCTION AND HYPOTHESIS We aim to analyze the combined influence of the size of the mesh, the number of sutures, the combined use of an anterior and posterior mesh, and the tension applied to the promontory, on the mobility of the pelvic organs and on the sutures, using a Finite Element (FE) model of the female pelvic system during abdominal sacral colpopexy. METHODS We used a FE model of the female pelvic system, which allowed us to simulate the mobility of the pelvic system and to evaluate problems related to female prolapse. The meshes were added to the geometrical model and then transferred to computing software. This analysis allowed us to compare the stress and mobility during a thrust effort in different situations. RESULTS The bigger the mesh, the less mobility of both anterior and posterior organs there would be. This is accompanied by an increase in stress at the suture level. The combination of a posterior mesh with an anterior one decreases mobility and stress at the suture level. There is a particularly relevant stressing zone on the suture at the cervix. The increase in the number of sutures induces a decrease in the tension applied at each suture zone and has no impact on organ mobility. CONCLUSION Our model enables us to simulate and analyze an infinite number of surgical hypotheses. Even if these results are not validated at a clinical level, we can observe the importance of the association of both an anterior and a posterior mesh or the number of sutures.
Collapse
|
14
|
Lamblin G, Delorme E, Cosson M, Rubod C. Cystocele and functional anatomy of the pelvic floor: review and update of the various theories. Int Urogynecol J 2015; 27:1297-305. [PMID: 26337427 DOI: 10.1007/s00192-015-2832-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 08/14/2015] [Indexed: 11/24/2022]
Abstract
INTRODUCTION AND HYPOTHESIS We updated anatomic theories of pelvic organ support to determine pathophysiology in various forms of cystocele. METHODS PubMed/MEDLINE, ScienceDirect, Cochrane Library, and Web of Science databases were searched using the terms pelvic floor, cystocele, anatomy, connective tissue, endopelvic fascia, and pelvic mobility. We retrieved 612 articles, of which 61 matched our topic and thus were selected. Anatomic structures of bladder support and their roles in cystocele onset were determined on the international anatomic classification; the various anatomic theories of pelvic organ support were reviewed and a synthesis was made of theories of cystocele pathophysiology. RESULTS Anterior vaginal support structures comprise pubocervical fascia, tendinous arcs, endopelvic fascia, and levator ani muscle. DeLancey's theory was based on anatomic models and, later, magnetic resonance imaging (MRI), establishing a three-level anatomopathologic definition of prolapse. Petros's integral theory demonstrated interdependence between pelvic organ support systems, linking ligament-fascia lesions, and clinical expression. Apical cystocele is induced by failure of the pubocervical fascia and insertion of its cervical ring; lower cystocele is induced by pubocervical fascia (medial cystocele) or endopelvic fascia failure at its arcus tendineus fasciae pelvis attachment (lateral cystocele). CONCLUSIONS Improved anatomic knowledge of vaginal wall support mechanisms will improve understanding of cystocele pathophysiology, diagnosis of the various types, and surgical techniques. The two most relevant theories, DeLancey's and Petros's, are complementary, enriching knowledge of pelvic functional anatomy, but differ in mechanism. Three-dimensional digital models could integrate and assess the mechanical properties of each anatomic structure.
Collapse
Affiliation(s)
- Géry Lamblin
- Département de Chirurgie Urogynécologique, Hôpital Femme Mère Enfant, Université Claude Bernard Lyon 1, Villeurbanne, France.
- Faculté de Médecine Henri Warembourg, Université Lille 2, 42 Rue Paul Duez, 59000, Lille, France.
- Department of Urogynecology, Femme Mère Enfant University Hospital, 59 Boulevard Pinel, 69677, Lyon-Bron, France.
| | - Emmanuel Delorme
- Service de Chirurgie Urologique, Hôpital Privé Sainte Marie, 4 Allée Saint Jean des Vignes, 71100, Chalon-sur-Saône, France
| | - Michel Cosson
- Faculté de Médecine Henri Warembourg, Université Lille 2, 42 Rue Paul Duez, 59000, Lille, France
- Clinique de Chirurgie Gynécologique, Hôpital Jeanne de Flandre, Université Lille 2, Avenue E Avinée, 59037, Lille Cedex, France
| | - Chrystèle Rubod
- Faculté de Médecine Henri Warembourg, Université Lille 2, 42 Rue Paul Duez, 59000, Lille, France
- Clinique de Chirurgie Gynécologique, Hôpital Jeanne de Flandre, Université Lille 2, Avenue E Avinée, 59037, Lille Cedex, France
| |
Collapse
|
15
|
Influence of Geometry and Mechanical Properties on the Accuracy of Patient-Specific Simulation of Women Pelvic Floor. Ann Biomed Eng 2015. [PMID: 26215307 DOI: 10.1007/s10439-015-1401-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The woman pelvic system involves multiple organs, muscles, ligaments, and fasciae where different pathologies may occur. Here we are most interested in abnormal mobility, often caused by complex and not fully understood mechanisms. Computer simulation and modeling using the finite element (FE) method are the tools helping to better understand the pathological mobility, but of course patient-specific models are required to make contribution to patient care. These models require a good representation of the pelvic system geometry, information on the material properties, boundary conditions and loading. In this contribution we focus on the relative influence of the inaccuracies in geometry description and of uncertainty of patient-specific material properties of soft connective tissues. We conducted a comparative study using several constitutive behavior laws and variations in geometry description resulting from the imprecision of clinical imaging and image analysis. We find that geometry seems to have the dominant effect on the pelvic organ mobility simulation results. Provided that proper finite deformation non-linear FE solution procedures are used, the influence of the functional form of the constitutive law might be for practical purposes negligible. These last findings confirm similar results from the fields of modeling neurosurgery and abdominal aortic aneurysms.
Collapse
|
16
|
Boubaker MB, Haboussi M, Ganghoffer JF, Aletti P. Predictive model of the prostate motion in the context of radiotherapy: A biomechanical approach relying on urodynamic data and mechanical testing. J Mech Behav Biomed Mater 2015; 49:30-42. [PMID: 25974099 DOI: 10.1016/j.jmbbm.2015.04.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2015] [Revised: 04/13/2015] [Accepted: 04/16/2015] [Indexed: 11/16/2022]
Abstract
In this paper, a biomechanical approach relying on urodynamic data and mechanical tests is proposed for an accurate prediction of the motion of the pelvic organs in the context of the prostate radiotherapy. As a first step, an experimental protocol is elaborated to characterize the mechanical properties of the bladder and rectum wall tissues; uniaxial tensile tests are performed on porcine substrates. In a second step, the parameters of Ogden-type hyperelastic constitutive models are identified; their relevance in the context of the implementation of a human biomechanical model is verified by means of preliminary Finite Elements (FE) simulations against human urodynamic data. In a third step, the identified constitutive equations are employed for the simulations of the motion and interactions of the pelvic organs due to concomitant changes of the distension volumes of the urinary bladder and rectum. The effectiveness of the developed biomechanical model is demonstrated in investigating the motion of the bladder, rectum and prostate organs; the results in terms of displacements are shown to be in good agreement with measurements inherent to a deceased person, with a relative error close to 6%.
Collapse
Affiliation(s)
| | - Mohamed Haboussi
- L.S.P.M., U.P.R., C.N.R.S. 3407 Université Paris 13, 99, av. J-B. Clément, 93430 Villetaneuse, France
| | - Jean-François Ganghoffer
- L.E.M.T.A., Université de Lorraine, C.N.R.S., 2 avenue de la forêt de Haye, TSA 60604, 54518 Vandoeuvre CEDEX, France.
| | - Pierre Aletti
- Centre Alexis Vautrin, C.R.A.N., I.N.P.L., C.N.R.S. 54500 Vandoeuvre Cedex, France
| |
Collapse
|
17
|
Brandão S, Parente M, Mascarenhas T, da Silva ARG, Ramos I, Jorge RN. Biomechanical study on the bladder neck and urethral positions: Simulation of impairment of the pelvic ligaments. J Biomech 2015; 48:217-23. [DOI: 10.1016/j.jbiomech.2014.11.045] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2014] [Revised: 11/04/2014] [Accepted: 11/28/2014] [Indexed: 11/28/2022]
|
18
|
Biomechanical pregnant pelvic system model and numerical simulation of childbirth: impact of delivery on the uterosacral ligaments, preliminary results. Int Urogynecol J 2014; 26:497-504. [DOI: 10.1007/s00192-014-2498-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2014] [Accepted: 08/24/2014] [Indexed: 11/24/2022]
|
19
|
Rubod C, Lecomte-Grosbras P, Brieu M, Giraudet G, Betrouni N, Cosson M. 3D simulation of pelvic system numerical simulation for a better understanding of the contribution of the uterine ligaments. Int Urogynecol J 2013; 24:2093-2098. [PMID: 23958831 DOI: 10.1007/s00192-013-2135-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2013] [Accepted: 05/14/2013] [Indexed: 11/30/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Genital prolapse remains a complex pathological condition. Physiopathology remains poorly understood, aetiology is multi-factorial, surgery is not always satisfying, as the rate of relapse cannot be overlooked. More over a good anatomical result will not always guarantee functional satisfaction. The aim of our study is to have a better understanding of the involvement of uterine ligaments in pelvic statics via 3D simulation. METHODS Simulation of pelvic mobility is performed with a validated numerical model in a normal situation (standing up to lying down) or induced pathological ones where parts of the constitutive elements of the model are virtually "cut" independently. Displacements are then discussed. RESULTS Numerical results have been compared with dynamic MRI for two volunteers. Dynamic sequences had 90 images, and 180 simulations have been validated. Results are coherent with clinical data and the literature, thus validating our mechanical approach. Uterine ligaments are involved in pelvic statics, but their lesions are not sufficient to generate a genital prolapse. Round ligaments play a part in uterine orientation; the utero-sacral ligaments support the uterus when standing up. CONCLUSIONS Pelvic normal and pathological mobility study via modelling and 3D simulation is a new strategy in understanding the complex multifactorial physiopathology of genital prolapse. This approach must be validated in a larger series of patients. Nevertheless, pelvic ligaments seem to play an important role in statics, especially, in agreement with a literature survey, utero-sacral ligaments in a standing position.
Collapse
Affiliation(s)
- C Rubod
- Gynaecology Department, Jeanne de Flandre Hospital, CHRU LILLE-Lille Nord University, 59000, Lille, France,
| | | | | | | | | | | |
Collapse
|
20
|
Iancu G, Doumouchtsis SK. A historical perspective and evolution of our knowledge on the cardinal ligament. Neurourol Urodyn 2013; 33:380-6. [PMID: 23754258 DOI: 10.1002/nau.22421] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2013] [Accepted: 04/02/2013] [Indexed: 11/10/2022]
Abstract
AIMS The objective of our review is to provide a critical appraisal of the literature on the anatomy, structure and roles of cardinal ligaments (CL) in pelvic organ support, in conjunction with the currently evolving evidence based mainly on imaging and biomechanical modeling studies. We aim to contribute to the understanding of the pathophysiology of pelvic organ prolapse (POP) and stimulate new insights in research and development of novel surgical approaches for POP. METHODS PubMed, Embase, Scopus-Elsevier, and Cochrane Databases were searched in English and German. Studies from 1870 to 2012 were identified. The keywords used were "cardinal ligament," "transverse cervical ligament," "Mackenrodt ligament," "parametrium," and "paracervix." Cross check and Google search of the reference lists were used for missing articles. RESULTS We identified 35 related articles. Located at the base of the broad ligament, the CL is a supportive structure that attaches the cervix and upper vagina to the pelvic wall. The ligament contains the uterine vessels and hypogastric plexus. It conducts most of the pelvic loading forces. On MRI, it appears as a web-like structure around the axis of the internal iliac vessels. Their clinical importance is based on the apical supportive role and lymphatic-rich structure, involved in dissemination of cervical cancer. CONCLUSIONS The structure and role of the CL have been long studied, but remained unclear. Recent studies on imaging and biomechanics have improved our understanding and provide new insights which may enable the development of new techniques in prolapse surgery.
Collapse
Affiliation(s)
- George Iancu
- Department of Obstetrics and Gynaecology, Urogynaecology/Female Pelvic Medicine and Reconstructive Surgery Unit, St George's Healthcare Trust, London, United Kingdom
| | | |
Collapse
|