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Mascolini MV, Carniel EL. In silico assessment of the reliability and performance of artificial sphincter for urinary incontinence. Artif Organs 2024. [PMID: 38895983 DOI: 10.1111/aor.14805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 03/07/2024] [Accepted: 06/02/2024] [Indexed: 06/21/2024]
Abstract
BACKGROUND The standard artificial urinary sphincter (AUS) is an implantable device for the treatment of urinary incontinence by applying a pressure loading around the urethra through an inflatable cuff, often inducing no-physiological stimulation up to tissue degenerative phenomena. A novel in silico approach is proposed to fill the gap of the traditional procedures by providing tools to quantitatively assess AUS reliability and performance based on AUS-urethra interaction. METHODS The approach requires the development of 3D numerical models of AUS and urethra, and experimental investigations to define their mechanical behaviors. Computational analyses are performed to simulate the urethral lumen occlusion by AUS inflation under different pressures, and the lumen opening by applying an intraluminal pressure progressively increased under the AUS action (Abaqus Explicit solver). The AUS reliability is evaluated in terms of tissue stimulation by the mechanical fields potentially responsible for vasoconstriction and tissue damage, while the performance by the intraluminal pressure that causes the lumen opening for a specific occlusive pressure, showing the maximum urethral pressure for which continence is guaranteed. RESULTS The present study implemented the procedure considering the gold standard AMS 800 and a novel patented AUS. Results provided the comparison between two sphincteric devices and the evaluation of the influence of different building materials and geometrical features on the AUS functionality. CONCLUSIONS The approach was developed for the AUS, but it could be adapted also to artificial sphincters for the treatment of other anatomical dysfunctions, widening the analyzable device configurations and reducing experimental and ethical efforts.
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Affiliation(s)
- Maria Vittoria Mascolini
- Department of Industrial Engineering, University of Padova, Padova, Italy
- Centre for Mechanics of Biological Materials, University of Padova, Padova, Italy
| | - Emanuele Luigi Carniel
- Department of Industrial Engineering, University of Padova, Padova, Italy
- Centre for Mechanics of Biological Materials, University of Padova, Padova, Italy
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Bonaldi L, Mascolini MV, Todesco M, Zara A, Rossato C, Fede C, Fontanella CG, Stecco C. Urinary Incontinence and Other Pelvic Floor Dysfunctions as Underestimated Problems in People under Forty Years: What Is Their Relationship with Sport? Life (Basel) 2023; 14:67. [PMID: 38255682 PMCID: PMC10817452 DOI: 10.3390/life14010067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 12/18/2023] [Accepted: 12/27/2023] [Indexed: 01/24/2024] Open
Abstract
Urinary incontinence is still an underestimated problem due to its anatomical complexity and social taboo. Most of the time, it is believed to affect predominantly the elderly female population, and the literature still lacks data on its presence in the younger and male populations. Its relationship with other pelvic floor dysfunctions (PFDs) and sport activity remains an open topic. Thus, the present study surveyed 342 subjects of both genders, ranging from 18 to 39 y/o and with different sport activity levels, to understand the prevalence of PFDs (such as haemorrhoids, anal fissures, involuntary urinary/faecal leakage, and urgency). The results also showed a significative prevalence in younger, sporty, and male people. Approximately one third of the population had urinary incontinence mostly during stress activities (sport activity: 17%, cough/sneeze: 13%). The statistical analysis confirmed a higher prevalence in the cases of a light (32%) and intense (41%) sport activity level and a protective role of sport if practiced between 5 and 10 h/week, with bodybuilding/CrossFit and running seeming to be the riskiest sports. The relationship with the other PFDs showed a statistically significant dependence with most of them, confirming that urinary incontinence cannot be considered a separate problem from the other PFDs.
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Affiliation(s)
- Lorenza Bonaldi
- Department of Civil, Environmental and Architectural Engineering, University of Padova, Via F. Marzolo 9, 35131 Padova, Italy;
| | - Maria Vittoria Mascolini
- Department of Industrial Engineering, University of Padova, Via Venezia 1, 35121 Padova, Italy; (M.V.M.); (C.G.F.)
| | - Martina Todesco
- Department of Civil, Environmental and Architectural Engineering, University of Padova, Via F. Marzolo 9, 35131 Padova, Italy;
| | - Anna Zara
- Department of Neuroscience, University of Padova, Via A. Gabelli 65, 35121 Padova, Italy; (A.Z.); (C.R.); (C.F.); (C.S.)
| | - Camilla Rossato
- Department of Neuroscience, University of Padova, Via A. Gabelli 65, 35121 Padova, Italy; (A.Z.); (C.R.); (C.F.); (C.S.)
| | - Caterina Fede
- Department of Neuroscience, University of Padova, Via A. Gabelli 65, 35121 Padova, Italy; (A.Z.); (C.R.); (C.F.); (C.S.)
| | - Chiara Giulia Fontanella
- Department of Industrial Engineering, University of Padova, Via Venezia 1, 35121 Padova, Italy; (M.V.M.); (C.G.F.)
- Centre for Mechanics of Biological Material (CMBM), University of Padova, Via F. Marzolo 9, 35131 Padova, Italy
| | - Carla Stecco
- Department of Neuroscience, University of Padova, Via A. Gabelli 65, 35121 Padova, Italy; (A.Z.); (C.R.); (C.F.); (C.S.)
- Centre for Mechanics of Biological Material (CMBM), University of Padova, Via F. Marzolo 9, 35131 Padova, Italy
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Liu C, Wang Z, Yan G, Jiang P, Wang L, Chen Y. Simulation of artificial anal sphincter motion and interaction with intestinal environment using SOFA. Artif Organs 2023; 47:1710-1719. [PMID: 37680050 DOI: 10.1111/aor.14632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 08/01/2023] [Accepted: 08/09/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND Artificial anal sphincter is an implantable medical device for treating fecal incontinence. Reasonable simulation facilitates the advancement of research and reduces experiments on biological tissue. However, the device's clamping motion and sensor interaction with the intestine in the simulation still require further exploration. This article presents a simulation of the artificial anal sphincter's clamping and sensing and its interaction with the intestinal environment using the Simulation Open Framework Architecture (SOFA). METHODS Firstly, the proposed simulation algorithm and its principles in SOFA are analyzed. Secondly, the clamping motion and sensor system of the artificial anal sphincter are simulated. Thirdly, a finite element model of intestine is established based on the properties of intestinal soft tissue. Finally, the in vitro experiments are performed. RESULTS The simulation results indicate that the sensor system of the artificial anal sphincter has good sensing performance during the clamping motion and fecal accumulation process. Experiments have shown that optimal sensory capabilities can be achieved as the posture of the artificial anal sphincter with a roll angle between 20° and 40°. The comparison demonstrates a mean absolute error of 10%-20% between simulation and in vitro experimental results for sensor forces, which verifies the effectiveness of the simulation. CONCLUSION The proposed novel simulation achieves a more comprehensive interaction between the artificial anal sphincter motion and intestinal environment. This study may provide more effective simulation data for guidance in improving the performance of sensor perception of artificial anal sphincter for further research.
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Affiliation(s)
- Changjing Liu
- School of Electronic Information and Electrical Engineering, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Engineering Research Center of Intelligent Addiction Treatment and Rehabilitation, Shanghai, China
| | - Zhiwu Wang
- School of Electronic Information and Electrical Engineering, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Engineering Research Center of Intelligent Addiction Treatment and Rehabilitation, Shanghai, China
| | - Guozheng Yan
- School of Electronic Information and Electrical Engineering, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Engineering Research Center of Intelligent Addiction Treatment and Rehabilitation, Shanghai, China
| | - Pingping Jiang
- School of Electronic Information and Electrical Engineering, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Engineering Research Center of Intelligent Addiction Treatment and Rehabilitation, Shanghai, China
| | - Lichao Wang
- School of Electronic Information and Electrical Engineering, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Engineering Research Center of Intelligent Addiction Treatment and Rehabilitation, Shanghai, China
| | - Yelin Chen
- School of Electronic Information and Electrical Engineering, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Engineering Research Center of Intelligent Addiction Treatment and Rehabilitation, Shanghai, China
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Wang M, Liao Y, Liu Y, Zhou W, Yu H. Development and future prospects of the artificial urinary sphincter. Artif Organs 2023; 47:1688-1699. [PMID: 37424277 DOI: 10.1111/aor.14606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 06/15/2023] [Accepted: 06/26/2023] [Indexed: 07/11/2023]
Abstract
BACKGROUND Urinary incontinence is a urinary disorder in which urine leaks out involuntarily. This disorder seriously affects the quality of life of patients. For patients with mild incontinence, conservative treatment and medication may be the ideal treatment modality, but for patients with severe incontinence, an artificial urinary sphincter is currently a better treatment option. METHODS In order to design an ideal artificial urinary sphincter, this article first searched and collected literature based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses searched strategy by selecting specific subject terms and reviewed the artificial urinary sphincters that are currently in the research stage based on different activation methods. RESULTS In response to the deficiencies of the existing artificial urinary sphincter, this article discusses the future optimization of the artificial urinary sphincter from three aspects: individual improvement of the artificial urinary sphincter, engineering design elements, and optimization of the artificial urinary sphincter manufacturing process. CONCLUSIONS The manufacture of an idealized artificial urinary sphincter capable of meeting clinical needs is of great importance to improve the quality of life of patients. However, this approach is a reasonable option to explore and should not be overestimated until further evidence is available.
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Affiliation(s)
- Minghui Wang
- Institute of Rehabilitation Engineering and Technology, School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
- Shanghai Engineering Research Center of Assistive Devices, School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
| | - Yucheng Liao
- Institute of Rehabilitation Engineering and Technology, School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
- Shanghai Engineering Research Center of Assistive Devices, School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
| | - Yunlong Liu
- Institute of Rehabilitation Engineering and Technology, School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
- Shanghai Engineering Research Center of Assistive Devices, School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
| | - Wei Zhou
- Institute of Rehabilitation Engineering and Technology, School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
- Shanghai Engineering Research Center of Assistive Devices, School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
| | - Hongliu Yu
- Institute of Rehabilitation Engineering and Technology, School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
- Shanghai Engineering Research Center of Assistive Devices, School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
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Liao Y, Wang M, Liu Y, Zhou W, Liu J, Yu H. Magnetically controlled artificial urinary sphincter: An overview from existing devices to future developments. Artif Organs 2023. [PMID: 37114754 DOI: 10.1111/aor.14535] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 04/04/2023] [Accepted: 04/06/2023] [Indexed: 04/29/2023]
Abstract
BACKGROUND Urinary incontinence is a common clinical problem in the world today. Artificial urinary sphincter is a good treatment approach for severe urinary incontinence, which is designed to mimic the action of the human urinary sphincter and assist patients to regain urinary function. METHODS There are many control methods based on artificial urinary sphincter, such as hydraulic control, electromechanical control, magnetic control, and shape memory alloy control. In this paper, the literature was first searched and documented based on PRISMA search strategy for selected specific subject terms. Then, a comparison of artificial urethral sphincters based on different control methods was conducted, and the research progress of magnetically controlled artificial urethral sphincters was reviewed, and their advantages and disadvantages were summarized. Finally, the design factors for the clinical application of magnetically controlled artificial urinary sphincter are discussed. RESULTS As magnetic control allows for non-contact force transfer and does not generate heat, it is proposed that magnetic control may be one of the more promising control methods. The design of future magnetically controlled artificial urinary sphincters will need a variety of considerations, including the structural design of the device, manufacturing materials, manufacturing costs, and convenience. In addition, validation of the safety and effectiveness of the device and device management are equally important. CONCLUSIONS The design of an ideal magnetically controlled artificial urinary sphincter is of great importance to enhance patient treatment outcomes. However, there are still great challenges to be faced for the clinical application of such devices.
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Affiliation(s)
- Yucheng Liao
- Institute of Rehabilitation Engineering and Technology, School of Intelligent Rehabilitation Engineering, University of Shanghai for Science and Technology, Shanghai, China
- Shanghai Engineering Research Center of Assistive Devices, Shanghai, China
| | - Minghui Wang
- Institute of Rehabilitation Engineering and Technology, School of Intelligent Rehabilitation Engineering, University of Shanghai for Science and Technology, Shanghai, China
- Shanghai Engineering Research Center of Assistive Devices, Shanghai, China
| | - Yunlong Liu
- Institute of Rehabilitation Engineering and Technology, School of Intelligent Rehabilitation Engineering, University of Shanghai for Science and Technology, Shanghai, China
- Shanghai Engineering Research Center of Assistive Devices, Shanghai, China
| | - Wei Zhou
- Institute of Rehabilitation Engineering and Technology, School of Intelligent Rehabilitation Engineering, University of Shanghai for Science and Technology, Shanghai, China
- Shanghai Engineering Research Center of Assistive Devices, Shanghai, China
| | - Ji Liu
- Institute of Rehabilitation Engineering and Technology, School of Intelligent Rehabilitation Engineering, University of Shanghai for Science and Technology, Shanghai, China
- Shanghai Engineering Research Center of Assistive Devices, Shanghai, China
| | - Hongliu Yu
- Institute of Rehabilitation Engineering and Technology, School of Intelligent Rehabilitation Engineering, University of Shanghai for Science and Technology, Shanghai, China
- Shanghai Engineering Research Center of Assistive Devices, Shanghai, China
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