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Yang M, Chen C, Wang Z, Long J, Huang R, Qi W, Shi R. Finite element analysis of female pelvic organ prolapse mechanism: current landscape and future opportunities. Front Med (Lausanne) 2024; 11:1342645. [PMID: 38323034 PMCID: PMC10844411 DOI: 10.3389/fmed.2024.1342645] [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: 11/22/2023] [Accepted: 01/05/2024] [Indexed: 02/08/2024] Open
Abstract
The prevalence of pelvic organ prolapse (POP) has been steadily increasing over the years, rendering it a pressing global health concern that significantly impacts women's physical and mental wellbeing as well as their overall quality of life. With the advancement of three-dimensional reconstruction and computer simulation techniques for pelvic floor structures, research on POP has progressively shifted toward a biomechanical focus. Finite element (FE) analysis is an established tool to analyze the biomechanics of complex systems. With the advancement of computer technology, an increasing number of researchers are now employing FE analysis to investigate the pathogenesis of POP in women. There is a considerable number of research on the female pelvic FE analysis and to date there has been less review of this technique. In this review article, we summarized the current research status of FE analysis in various types of POP diseases and provided a detailed explanation of the issues and future development in pelvic floor disorders. Currently, the application of FE analysis in POP is still in its exploratory stage and has inherent limitations. Through continuous development and optimization of various technologies, this technique can be employed with greater accuracy to depict the true functional state of the pelvic floor, thereby enhancing the supplementation of the POP mechanism from the perspective of computer biomechanics.
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Affiliation(s)
- Miyang Yang
- The First Clinical Medical College, The Affiliated People's Hospital of Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China
| | - Chujie Chen
- The First Clinical Medical College, The Affiliated People's Hospital of Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China
| | - Zhaochu Wang
- Department of Anorectal, The Affiliated People's Hospital of Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China
| | - Jiaye Long
- Department of Interventional Radiology, Inner Mongolia Forestry General Hospital, The Second Clinical Medical School of Inner Mongolia University for The Nationalities, Yakeshi, China
| | - Runyu Huang
- The First Clinical Medical College, The Affiliated People's Hospital of Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China
| | - Wan Qi
- Department of Radiology, The Affiliated People's Hospital of Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China
| | - Rong Shi
- Department of Anorectal, The Affiliated People's Hospital of Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China
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2
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Zhao Z, Huang G, He Y, Zuo X, Han W, Li H. Estrogen inhibits the differentiation of fibroblasts induced by high stiffness matrix by enhancing DNMT1 expression. Tissue Cell 2023; 85:102207. [PMID: 37708582 DOI: 10.1016/j.tice.2023.102207] [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: 03/23/2023] [Revised: 08/28/2023] [Accepted: 08/28/2023] [Indexed: 09/16/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Pelvic organ prolapse(POP) is a multifactorial connective tissue disorder caused by damage to the supporting structures of the pelvic floor. Evidence from several studies suggests that anterior vaginal wall stiffness is higher in patients with POP, but the mechanisms involved remain unknown. METHODS Tissue from the anterior vaginal wall of patients with POP or other benign diseases was obtained. The modulus of elasticity of the anterior vaginal wall was measured using a microindenter. Cells were cultured in vitro on acrylamide gels of different stiffness and treated with DNMT1 inhibitor, microtubule polymerisation inhibitor and estrogen. Western blot or immunohistochemical staining was performed to detect DNA Methyltransferase 1, α-smooth muscle actin(α-SMA) expression, and connective tissue growth factor(CTGF) expression. CONCLUSION Estrogen can inhibit high stiffness matrix-induced fibroblast differentiation, by enhancing DNMT1 expression. This study may help to elucidate the complex crosstalk between fibroblasts and their surrounding matrix under healthy and pathological conditions and provide new insights into the options for material-related therapeutic applications.
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Affiliation(s)
- Zhihan Zhao
- Department of Gynecology and Obstetrics, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei Province, PR China
| | - Guotao Huang
- Department of Gynecology and Obstetrics, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei Province, PR China
| | - Yong He
- Department of Gynecology and Obstetrics, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei Province, PR China
| | - Xiaohu Zuo
- Department of Gynecology and Obstetrics, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei Province, PR China
| | - Wuyue Han
- Department of Gynecology and Obstetrics, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei Province, PR China
| | - Hong Li
- Department of Gynecology and Obstetrics, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei Province, PR China.
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3
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Miller B, Wolfe W, Gentry JL, Grewal MG, Highley CB, De Vita R, Vaughan MH, Caliari SR. Supramolecular Fibrous Hydrogel Augmentation of Uterosacral Ligament Suspension for Treatment of Pelvic Organ Prolapse. Adv Healthc Mater 2023; 12:e2300086. [PMID: 37220996 DOI: 10.1002/adhm.202300086] [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: 01/08/2023] [Revised: 05/11/2023] [Indexed: 05/25/2023]
Abstract
Uterosacral ligament suspension (USLS) is a common surgical treatment for pelvic organ prolapse (POP). However, the relatively high failure rate of up to 40% underscores a strong clinical need for complementary treatment strategies, such as biomaterial augmentation. Herein, the first hydrogel biomaterial augmentation of USLS in a recently established rat model is described using an injectable fibrous hydrogel composite. Supramolecularly-assembled hyaluronic acid (HA) hydrogel nanofibers encapsulated in a matrix metalloproteinase (MMP)-degradable HA hydrogel create an injectable scaffold showing excellent biocompatibility and hemocompatibility. The hydrogel can be successfully delivered and localized to the suture sites of the USLS procedure, where it gradually degrades over six weeks. In situ mechanical testing 24 weeks post-operative in the multiparous USLS rat model shows the ultimate load (load at failure) to be 1.70 ± 0.36 N for the intact uterosacral ligament (USL), 0.89 ± 0.28 N for the USLS repair, and 1.37 ± 0.31 N for the USLS + hydrogel (USLS+H) repair (n = 8). These results indicate that the hydrogel composite significantly improves load required for tissue failure compared to the standard USLS, even after the hydrogel degrades, and that this hydrogel-based approach can potentially reduce the high failure rate associated with USLS procedures.
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Affiliation(s)
- Beverly Miller
- Department of Chemical Engineering, University of Virginia, Charlottesville, VA, 22903, USA
| | - Wiley Wolfe
- Scripps Institution of Oceanography, University of California, San Diego, La Jolla, CA, 92 093, USA
| | - James L Gentry
- Department of Biomedical Engineering, University of Virginia, Charlottesville, VA, 22 903, USA
| | - M Gregory Grewal
- Department of Chemical Engineering, University of Virginia, Charlottesville, VA, 22903, USA
| | - Christopher B Highley
- Department of Chemical Engineering, University of Virginia, Charlottesville, VA, 22903, USA
- Department of Biomedical Engineering, University of Virginia, Charlottesville, VA, 22 903, USA
| | - Raffaella De Vita
- Stretch Lab, Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, VA, 24 061, USA
| | - Monique H Vaughan
- Department of Obstetrics and Gynecology, University of Virginia, Charlottesville, VA, 22 903, USA
| | - Steven R Caliari
- Department of Chemical Engineering, University of Virginia, Charlottesville, VA, 22903, USA
- Department of Biomedical Engineering, University of Virginia, Charlottesville, VA, 22 903, USA
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4
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Non-invasive biomechanical assessment of the prolapsed vaginal wall: an explorative pilot study on cutometry and indentometry. Sci Rep 2023; 13:2751. [PMID: 36797400 PMCID: PMC9935514 DOI: 10.1038/s41598-023-29403-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 02/03/2023] [Indexed: 02/18/2023] Open
Abstract
The clinical assessment of pelvic organ prolapse (POP) and associated treatment strategies is currently limited to anatomical and subjective outcome measures, which have limited reproducibility and do not include functional properties of vaginal tissue. The objective of our study was to evaluate the feasibility of using cutometry and indentometry for non-invasive biomechanical assessment of the vaginal wall in women with POP. Both techniques were applied on the vaginal wall of 20 women indicated for surgical correction of POP stage two or higher. The primary outcome was the measurement success rate. Measurements were considered successful if biomechanical parameters were generated after a maximum of three attempts. Secondary outcomes included acquisition time, number of attempts to obtain a successful measurement, and biomechanical parameters. Measurements were successfully performed on the anterior vaginal wall of 12 women with cystocele and the posterior vaginal wall of eight women with rectocele. The success rate was 100% for both techniques and acquisition time was under 1 minute for all 20 measurements. Tissue fast elasticity of the posterior vaginal wall (rectocele) was significantly higher than that of the anterior vaginal wall (cystocele) and negatively correlated with age (r = - 0.57, P < 0.05). In women with POP, measuring the biomechanical properties of the vaginal wall using cutometry and indentometry is technically feasible. Objective evaluation of biomechanical properties may help to understand the pathophysiology behind surgical outcomes, providing an opportunity for the identification of patients at risk for (recurrent) prolapse, and individualized treatment decisions.
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5
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Laursen SH, Hansen SG, Taskin MB, Chen M, Wogensen L, Nygaard JV, Axelsen SM. Electrospun nanofiber mesh with connective tissue growth factor and mesenchymal stem cells for pelvic floor repair: Long-term study. J Biomed Mater Res B Appl Biomater 2023; 111:392-401. [PMID: 36075108 PMCID: PMC10087977 DOI: 10.1002/jbm.b.35158] [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: 11/09/2021] [Revised: 05/13/2022] [Accepted: 08/21/2022] [Indexed: 12/15/2022]
Abstract
Pelvic organ prolapse (POP) affects many women, with an estimated lifetime risk of surgical intervention of 18.7%. There is a need for alternative approaches as the use of synthetic nondegradable mesh was stopped due to severe adverse events, and as current methods for pelvic floor repair have high POP recurrence rates. Thus, we hypothesized that electrospun degradable meshes with stem cells and growth factor were safe and durable for the long term in elderly rats. In an abdominal repair model, electrospun polycaprolactone (PCL) meshes coated with connective tissue growth factor (CTGF)/PEG-fibrinogen (PF) and rat mesenchymal stem cells were implanted in elderly female rats and removed after in average 53 weeks (53-week group). Collagen amount and production were quantified by qPCR and Western blotting. Moreover, histological appearance and biomechanical properties were evaluated. Results were compared with previous results of young rats with identical mesh implanted for 24 weeks (24-week group). The 53-week group differed from the 24-week group in terms of (1) reduced collagen III, (2) strong reduction in foreign body response, and (3) altered histological appearance. We found comparable biomechanical properties, aside from higher, not significant, mean tissue stiffness in the 53-week group. Lastly, we identified mesh components 53 weeks after implantation. This study provides new insights into future POP repair in postmenopausal women by showing how CTGF/PF-coated electrospun PCL meshes with stem cells exhibit sufficient support, biocompatibility, and no mesh-related complications long term in an abdominal repair model in elderly rats.
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Affiliation(s)
- Sofie Husted Laursen
- Department of Gynaecology and Obstetrics, Aarhus University Hospital, Aarhus, Denmark
| | | | - Mehmet Berat Taskin
- Leibniz Institute of Polymer Research Dresden, Max Bergmann Center of Biomaterials Dresden, Dresden, Germany
| | - Menglin Chen
- Department of Biological and Chemical Engineering - Medical Biotechnology, Aarhus University, Aarhus, Denmark
| | | | - Jens Vinge Nygaard
- Department of Biological and Chemical Engineering - Medical Biotechnology, Aarhus University, Aarhus, Denmark
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Mardina Z, Venezuela J, Maher C, Shi Z, Dargusch M, Atrens A. Design, mechanical and degradation requirements of biodegradable metal mesh for pelvic floor reconstruction. Biomater Sci 2022; 10:3371-3392. [DOI: 10.1039/d2bm00179a] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Pelvic organ prolapse (POP) is the herniation of surrounding tissue and organs into the vagina and or rectum, and is a result of weakening of pelvic floor muscles, connective tissue,...
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7
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Clark-Patterson GL, Roy S, Desrosiers L, Knoepp LR, Sen A, Miller KS. Role of fibulin-5 insufficiency and prolapse progression on murine vaginal biomechanical function. Sci Rep 2021; 11:20956. [PMID: 34697337 PMCID: PMC8546087 DOI: 10.1038/s41598-021-00351-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 08/31/2021] [Indexed: 02/04/2023] Open
Abstract
The vagina plays a critical role in supporting the pelvic organs and loss of support leads to pelvic organ prolapse. It is unknown what microstructural changes influence prolapse progression nor how decreased elastic fibers contributes to vaginal remodeling and smooth muscle contractility. The objective for this study was to evaluate the effect of fibulin-5 haploinsufficiency, and deficiency with progressive prolapse on the biaxial contractile and biomechanical function of the murine vagina. Vaginas from wildtype (n = 13), haploinsufficient (n = 13), and deficient mice with grade 1 (n = 9) and grade 2 or 3 (n = 9) prolapse were explanted for biaxial contractile and biomechanical testing. Multiaxial histology (n = 3/group) evaluated elastic and collagen fiber microstructure. Western blotting quantified protein expression (n = 6/group). A one-way ANOVA or Kruskal-Wallis test evaluated statistical significance. Pearson's or Spearman's test determined correlations with prolapse grade. Axial contractility decreased with fibulin-5 deficiency and POP (p < 0.001), negatively correlated with prolapse grade (ρ = - 0.80; p < 0.001), and positively correlated with muscularis elastin area fraction (ρ = - 0.78; p = 0.004). Circumferential (ρ = 0.71; p < 0.001) and axial (ρ = 0.69; p < 0.001) vaginal wall stresses positively correlated with prolapse grade. These findings demonstrated that fibulin-5 deficiency and prolapse progression decreased vaginal contractility and increased vaginal wall stress. Future work is needed to better understand the processes that contribute to prolapse progression in order to guide diagnostic, preventative, and treatment strategies.
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Affiliation(s)
| | - Sambit Roy
- Department of Animal Sciences, Reproductive and Developmental Sciences Program, Michigan State University, East Lansing, 48824, USA
| | - Laurephile Desrosiers
- Department of Female Pelvic Medicine and Reconstructive Surgery, University of Queensland Ochsner Clinical School, New Orleans, 70121, USA
| | - Leise R Knoepp
- Department of Female Pelvic Medicine and Reconstructive Surgery, University of Queensland Ochsner Clinical School, New Orleans, 70121, USA
| | - Aritro Sen
- Department of Animal Sciences, Reproductive and Developmental Sciences Program, Michigan State University, East Lansing, 48824, USA
| | - Kristin S Miller
- Department of Biomedical Engineering, Tulane University, New Orleans, 70118, USA.
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Somerwil PC, Nout RA, Mens JWM, Kolkman-Deurloo IKK, van Beekhuizen HJ, Dankelman J, van de Berg NJ. An anthropomorphic deformable phantom of the vaginal wall and cavity. Biomed Phys Eng Express 2021; 7. [PMID: 34298530 DOI: 10.1088/2057-1976/ac1780] [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: 05/28/2021] [Accepted: 07/23/2021] [Indexed: 11/12/2022]
Abstract
Brachytherapy is a common treatment in cervical, uterine and vaginal cancer management. The technique is characterised by rapid developments in the fields of medical imaging, dosimetry planning and personalised medical device design. To reduce unnecessary burden on patients, assessments and training of these technologies should preferable be done using high-fidelity physical phantoms. In this study, anthropomorphic deformable phantoms of the vaginal wall and cavity were developed for image-guided adaptive brachytherapy, in which vaginal wall biomechanics were mimicked. Phantoms were produced from both silicone and polyvinyl alcohol materials. Material characterisations were performed with uniaxial tensile tests, via which Young's moduli and toughness were quantified. In addition, the contrast between adjacent phantom layers was quantified in magnetic resonance images. The results showed that stress-strain curves of the silicone phantoms were within the range of those found in healthy human vaginal wall tissues. Sample preconditioning had a large effect on Young's moduli, which ranged between 2.13 and 6.94 MPa in silicone. Toughness was a more robust and accurate metric for biomechanical matching, and ranged between 0.23 and 0.28 ·106J·m-3as a result of preconditioning. The polyvinyl alcohol phantoms were not stiff or tough enough, with a Young's modulus of 0.16 MPa and toughness of 0.02 ·106J·m-3. All materials used could be clearly delineated in magnetic resonance images, although the MRI sequence did affect layer contrast. In conclusion, we developed anthropomorphic deformable phantoms that mimic vaginal wall tissue and are well visible in magnetic resonance images. These phantoms will be used to evaluate the properties and to optimise the development and use of personalised brachytherapy applicators.
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Affiliation(s)
- Philip C Somerwil
- Department of Biomechanical Engineering, Delft University of Technology, Delft, The Netherlands
| | - Remi A Nout
- Department of Radiotherapy, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Jan-Willem M Mens
- Department of Radiotherapy, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Inger-Karine K Kolkman-Deurloo
- Department of Radiotherapy, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Heleen J van Beekhuizen
- Department of Gynaecological Oncology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Jenny Dankelman
- Department of Biomechanical Engineering, Delft University of Technology, Delft, The Netherlands
| | - Nick J van de Berg
- Department of Biomechanical Engineering, Delft University of Technology, Delft, The Netherlands.,Department of Gynaecological Oncology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
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Dahal S, Kuang M, Rietsch A, Butler RS, Ramamurthi A, Damaser MS. Quantitative Morphometry of Elastic Fibers in Pelvic Organ Prolapse. Ann Biomed Eng 2021; 49:1909-1922. [PMID: 33768411 DOI: 10.1007/s10439-021-02760-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Accepted: 02/22/2021] [Indexed: 12/17/2022]
Abstract
Pelvic organ prolapse (POP) is common among older women who have delivered children vaginally. While the pathophysiology is not fully delineated, POP can occur in part from insufficient repair of disrupted elastic matrix fibers. Quantification of structural changes to elastic fibers has not been described previously for POP. The goal of this paper is to present a validated technique for morphometric analysis of elastic fibers in vaginal tissue cultures from lysyl oxidase like-1 knock out (LOXL1 KO) mice with POP. The effect of LOXL1 KO, effect of POP, effect of culture, and effect of elastogenic treatment on the changes in elastin fiber characteristics were tested using vaginal tissues from wild type multiparous (WT), LOXL1 KO multiparous prolapsed (POP) and LOXL1 KO multiparous non-prolapsed (NP) mice. Our results show significantly higher mean aspect ratio, maximum diameter and perimeter length in POP compared to NP after 3 weeks of tissue culture. Further, treatment of POP tissues in culture with growth factors with previously documented elastogenic effects caused a significant increase in the mean area and perimeter length of elastic fibers. This technique thus appears to be useful in quantifying structural changes and can be used to assess the pathophysiology of POP and the effect of elastogenic treatments with potential for POP.
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Affiliation(s)
- Shataakshi Dahal
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Ave. ND20, Cleveland, OH, 44195, USA
| | - Mei Kuang
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Ave. ND20, Cleveland, OH, 44195, USA
- Advanced Platform Technology Center, Louis Stokes Cleveland VA Medical Center, Cleveland, OH, USA
| | - Anna Rietsch
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Ave. ND20, Cleveland, OH, 44195, USA
- Advanced Platform Technology Center, Louis Stokes Cleveland VA Medical Center, Cleveland, OH, USA
| | - R S Butler
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
| | - Anand Ramamurthi
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Ave. ND20, Cleveland, OH, 44195, USA
- Department of Biomedical Engineering, Cleveland Clinic Lerner College of Medicine at Case Western Reserve University, Cleveland, OH, USA
| | - Margot S Damaser
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Ave. ND20, Cleveland, OH, 44195, USA.
- Advanced Platform Technology Center, Louis Stokes Cleveland VA Medical Center, Cleveland, OH, USA.
- Department of Biomedical Engineering, Cleveland Clinic Lerner College of Medicine at Case Western Reserve University, Cleveland, OH, USA.
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA.
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10
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Bickhaus JA, Fraser MO, Weidner AC, Jayes FL, Amundsen CL, Gall K, Miller AT, Marini FC, Robboy SJ, Siddiqui NY. Polycarbonate Urethane Mesh: A New Material for Pelvic Reconstruction. Female Pelvic Med Reconstr Surg 2021; 27:e469-e475. [PMID: 33105344 DOI: 10.1097/spv.0000000000000964] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Polycarbonate urethane (PCU) is a new biomaterial, and its mechanical properties can be tailored to match that of vaginal tissue. We aimed to determine whether vaginal host immune and extracellular matrix responses differ after PCU versus lightweight polypropylene (PP) mesh implantation. METHODS Hysterectomy and ovariectomy were performed on 24 Sprague-Dawley rats. Animals were divided into 3 groups: (1) PCU vaginal mesh, (2) PP vaginal mesh, and (3) sham controls. Vagina-mesh complexes or vaginas (controls) were excised 90 days after surgery. We quantified responses by comparing: (1) histomorphologic scoring of hematoxylin and eosin- and Masson trichrome-stained slides, (2) macrophage subsets (immunolabeling), (3) pro-inflammatory and anti-inflammatory cytokines (Luminex panel), (4) matrix metalloproteinase (MMP)-2 and -9 using an enzyme-linked immunosorbent assay, and (5) type I/III collagen using picrosirius red staining. RESULTS There was no difference in histomorphologic score between PCU and PP (P = 0.211). Although the histomorphologic response was low surrounding all mesh fibers, groups with PCU and PP mesh had a higher histomorphologic score than the control group (P < 0.005 and P < 0.002, respectively). There were no differences between groups in terms of macrophage subsets, pro-inflammatory cytokines, anti-inflammatory cytokines, MMP-2 and MMP-9, or collagen ratio. CONCLUSIONS Polycarbonate urethane, an elastomer with material properties similar to those of vaginal tissue, elicits minimal host inflammatory responses in a rat model. Because its implantation does not elicit more inflammation than currently used lightweight PP, using PCU for prolapse mesh warrants further investigation with larger animal models.
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Affiliation(s)
- Jennifer A Bickhaus
- From the Department of Obstetrics and Gynecology, Duke University Medical Center
| | | | - Alison C Weidner
- From the Department of Obstetrics and Gynecology, Duke University Medical Center
| | - Friederike L Jayes
- From the Department of Obstetrics and Gynecology, Duke University Medical Center
| | - Cindy L Amundsen
- From the Department of Obstetrics and Gynecology, Duke University Medical Center
| | - Ken Gall
- Mechanical Engineering and Materials Science, Duke University, Durham
| | - Andrew T Miller
- Mechanical Engineering and Materials Science, Duke University, Durham
| | - Frank C Marini
- Wake Forest Institute for Regenerative Medicine, Wake Forest University, Winston-Salem
| | - Stanley J Robboy
- Department of Pathology, Duke University Medical Center, Durham, NC
| | - Nazema Y Siddiqui
- From the Department of Obstetrics and Gynecology, Duke University Medical Center
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11
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Investigating the birth-related caudal maternal pelvic floor muscle injury: The consequences of low cycle fatigue damage. J Mech Behav Biomed Mater 2020; 110:103956. [PMID: 32957249 DOI: 10.1016/j.jmbbm.2020.103956] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 06/22/2020] [Accepted: 06/24/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND One of the major causes of pelvic organ prolapse is pelvic muscle injury sustained during a vaginal delivery. The most common site of this injury is where the pubovisceral muscle takes origin from the pubic bone. We hypothesized that it is possible for low-cycle material fatigue to occur at the origin of the pubovisceral muscle under the large repetitive loads associated with pushing during the second stage of a difficult labor. PURPOSE The main goal was to test if the origin of the pubovisceral muscle accumulates material damage under sub-maximal cyclic tensile loading and identify any microscopic evidence of such damage. METHODS Twenty origins of the ishiococcygeous muscle (homologous to the pubovisceral muscle in women) were dissected from female sheep pelvises. Four specimens were stretched to failure to characterize the failure properties of the specimens. Thirteen specimens were then subjected to relaxation and subsequent fatigue tests, while three specimens remained as untested controls. Histology was performed to check for microscopic damage accumulation. RESULTS The fatigue stress-time curves showed continuous stress softening, a sign of material damage accumulation. Histology confirmed the presence of accumulated microdamage in the form of kinked muscle fibers and muscle fiber disruption in the areas with higher deformation, namely in the muscle near the musculotendinous junction. CONCLUSIONS The origin of ovine ishiococcygeous muscle can accumulate damage under sub-maximal repetitive loading. The damage appears in the muscle near the musculotendinous junction and was sufficient to negatively affect the macroscopic mechanical properties of the specimens.
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12
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Pack E, Dubik J, Snyder W, Simon A, Clark S, De Vita R. Biaxial Stress Relaxation of Vaginal Tissue in Pubertal Gilts. J Biomech Eng 2020; 142:1071956. [PMID: 31833537 DOI: 10.1115/1.4045707] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Indexed: 01/04/2023]
Abstract
Pelvic organ prolapse (POP) is a condition characterized by displacement of the vagina from its normal anatomical position leading to symptoms such as incontinence, physical discomfort, and poor self-image. Conservative treatment has shown limited success and surgical procedures, including the use of mesh, often lead to severe complications. To improve the current treatment methods for prolapse, the viscoelastic properties of vaginal tissue need to be characterized. We determined the biaxial stress relaxation response of vaginal tissue isolated from healthy pubertal gilts. Square specimens (n = 20) with sides aligned along the longitudinal directions (LD) and circumferential direction (CD) of the vagina were biaxially displaced up to 5 N. The specimens were then kept at the displacements corresponding to 5 N for 20 min in both the LD and CD, and the corresponding strains were measured using digital image correlation (DIC). The stresses in the LD and CD were found to decrease by 49.91 ± 5.81% and 46.22 ± 5.54% after 20 min, respectively. The strain in the LD and CD increased slightly from 0.080 ± 0.054 to 0.091 ± 0.064 and 0.050 ± 0.039 to 0.058 ± 0.047, respectively, but these changes were not significant (p > 0.01). By using the Peleg model, the initial decay rate and the asymptotic stress during stress relaxation were found to be significantly higher in the LD than in the CD (p≪0.001), suggesting higher stress relaxation in the LD. These findings may have implications for improving current surgical mesh, mechanical devices, and physical therapy used for prolapse treatment.
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Affiliation(s)
- Erica Pack
- School of Plant and Environmental Sciences, Virginia Tech, Blacksburg, VA 24061; STRETCH Lab, Department of Biomedical Engineering and Mechanics, and School of Plant and Environmental Sciences, Virginia Tech, Blacksburg, VA 24061
| | - Justin Dubik
- STRETCH Lab, Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, VA 24061
| | - William Snyder
- STRETCH Lab, Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, VA 24061
| | - Alexander Simon
- Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, VA 24061
| | - Sherrie Clark
- Department of Large Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Virginia Tech, Blacksburg, VA 24061
| | - Raffaella De Vita
- STRETCH Lab, Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, VA 24061
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13
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Landmarks in vaginal mesh development: polypropylene mesh for treatment of SUI and POP. Nat Rev Urol 2019; 16:675-689. [PMID: 31548731 DOI: 10.1038/s41585-019-0230-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/20/2019] [Indexed: 01/03/2023]
Abstract
Vaginal meshes used in the treatment of stress urinary incontinence (SUI) and pelvic organ prolapse (POP) have produced highly variable outcomes, causing life-changing complications in some patients while providing others with effective, minimally invasive treatments. The risk:benefit ratio when using vaginal meshes is a complex issue in which a combination of several factors, including the inherent incompatibility of the mesh material with some applications in pelvic reconstructive surgeries and the lack of appropriate regulatory approval processes at the time of the premarket clearance of these products, have contributed to the occurrence of complications caused by vaginal mesh. Surgical mesh used in hernia repair has evolved over many years, from metal implants to knitted polymer meshes that were adopted for use in the pelvic floor for treatment of POP and SUI. The evolution of the material and textile properties of the surgical mesh was guided by clinical feedback from hernia repair procedures, which were also being modified to obtain the best outcomes with use of the mesh. Current evidence shows how surgical mesh fails biomechanically when used in the pelvic floor and materials with improved performance can be developed using modern material processing and tissue engineering techniques.
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14
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Clark GL, Pokutta-Paskaleva AP, Lawrence DJ, Lindsey SH, Desrosiers L, Knoepp LR, Bayer CL, Gleason RL, Miller KS. Smooth muscle regional contribution to vaginal wall function. Interface Focus 2019; 9:20190025. [PMID: 31263538 PMCID: PMC6597518 DOI: 10.1098/rsfs.2019.0025] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2019] [Indexed: 12/16/2022] Open
Abstract
Pelvic organ prolapse is characterized as the descent of the pelvic organs into the vaginal canal. In the USA, there is a 12% lifetime risk for requiring surgical intervention. Although vaginal childbirth is a well-established risk factor for prolapse, the underlying mechanisms are not fully understood. Decreased smooth muscle organization, composition and maximum muscle tone are characteristics of prolapsed vaginal tissue. Maximum muscle tone of the vaginal wall was previously investigated in the circumferential or axial direction under uniaxial loading; however, the vaginal wall is subjected to multiaxial loads. Further, the contribution of vaginal smooth muscle basal (resting) tone to mechanical function remains undetermined. The objectives of this study were to determine the contribution of smooth muscle basal and maximum tone to the regional biaxial mechanical behaviour of the murine vagina. Vaginal tissue from C57BL/6 mice was subjected to extension-inflation protocols (n = 10) with and without basal smooth muscle tone. Maximum tone was induced with KCl under various circumferential (n = 5) and axial (n = 5) loading conditions. The microstructure was visualized with multiphoton microscopy (n = 1), multiaxial histology (n = 4) and multiaxial immunohistochemistry (n = 4). Smooth muscle basal tone decreased material stiffness and increased anisotropy. In addition, maximum vaginal tone was decreased with increasing intraluminal pressures. This study demonstrated that vaginal muscle tone contributed to the biaxial mechanical response of murine vaginal tissue. This may be important in further elucidating the underlying mechanisms of prolapse, in order to improve current preventative and treatment strategies.
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Affiliation(s)
- Gabrielle L. Clark
- Department of Biomedical Engineering, Tulane University, 6823 St Charles Avenue, New Orleans, LA 70118, USA
| | - Anastassia P. Pokutta-Paskaleva
- The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, 801 Ferst Drive NW, Atlanta, GA 30332, USA
| | - Dylan J. Lawrence
- Department of Biomedical Engineering, Tulane University, 6823 St Charles Avenue, New Orleans, LA 70118, USA
| | - Sarah H. Lindsey
- Department of Pharmacology, Tulane University School of Medicine, 1430 Tulane Avenue, New Orleans, LA 70112, USA
| | - Laurephile Desrosiers
- Department of Female Pelvic Medicine and Reconstructive Surgery, University of Queensland Ochsner Clinical School, 1514 Jefferson Highway, New Orleans, LA 70121, USA
| | - Leise R. Knoepp
- Department of Female Pelvic Medicine and Reconstructive Surgery, University of Queensland Ochsner Clinical School, 1514 Jefferson Highway, New Orleans, LA 70121, USA
| | - Carolyn L. Bayer
- Department of Biomedical Engineering, Tulane University, 6823 St Charles Avenue, New Orleans, LA 70118, USA
| | - Rudolph L. Gleason
- The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, 801 Ferst Drive NW, Atlanta, GA 30332, USA
- The George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, GA 30332, USA
| | - Kristin S. Miller
- Department of Biomedical Engineering, Tulane University, 6823 St Charles Avenue, New Orleans, LA 70118, USA
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15
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Gordon MT, DeLancey JOL, Renfroe A, Battles A, Chen L. Development of anatomically based customizable three-dimensional finite-element model of pelvic floor support system: POP-SIM1.0. Interface Focus 2019; 9:20190022. [PMID: 31263537 PMCID: PMC6597525 DOI: 10.1098/rsfs.2019.0022] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/07/2019] [Indexed: 12/24/2022] Open
Abstract
To develop an anatomically based customizable finite-element (FE) model of the pelvic floor support system to simulate pelvic organ prolapse (POP): POP-SIM1.0. This new simulation platform allows for the construction of an array of models that objectively represent the key anatomical and functional variation in women with and without prolapse to test pathomechanism hypotheses of the prolapse formation. POP-SIM1.0 consists of anatomically based FE models and a suite of Python-based tools developed to rapidly construct FE models by customizing the base model with desired structural parameters. Each model consists of anatomical structures from three support subsystems which can be customized based on magnetic resonance image measurements in women with and without prolapse. The customizable structural parameters include presence of levator ani (LA) avulsion, hiatus size, anterior vaginal wall dimension, attachment fascia length and apical location in addition to the tissue material properties and intra-abdominal pressure loading. After customization, the FE model was loaded with increasing intra-abdominal pressure (0-100 cmH2O) and solved using ABAQUS explicit solver. We were able to rapidly construct anatomically based FE models with specific structural geometry which reflects the morphology changes often observed in women with prolapse. At maximum loading, simulated structural deformations have similar anatomical characteristics to those observed during clinical exams and stress magnetic resonance images. Simulation results showed the presence of LA muscle avulsion negatively impacts the pelvic floor support. The normal model with intact muscle had the smallest exposed vaginal length of 11 mm, while the bilateral avulsion produced the largest exposed vaginal length at 24 mm. The unilateral avulsion model had an exposed vaginal length of 18 mm and also demonstrated a tipped perineal body similar to that seen in clinical observation. Increasing the hiatus size, vaginal wall length and fascia length also resulted in worse pelvic floor support, increasing the exposed vaginal length from 18 mm in the base model to 33 mm, 54 mm and 23.5 mm, respectively. The developed POP-SIM1.0 can simulate the anatomical structure changes often observed in women with prolapse. Preliminary results showed that the presence of LA avulsion, enlarged hiatus, longer vaginal wall and fascia length can result in larger prolapse at simulated maximum Valsalva.
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Affiliation(s)
- Mark T. Gordon
- Department of Bioengineering, California Baptist University, Riverside, CA, USA
| | - John O. L. DeLancey
- Department of Obstetrics and Gynecology, Pelvic Floor Research Group, University of Michigan, Ann Arbor, MI, USA
| | - Aaron Renfroe
- Department of Bioengineering, California Baptist University, Riverside, CA, USA
| | - Andrew Battles
- Department of Bioengineering, California Baptist University, Riverside, CA, USA
| | - Luyun Chen
- Department of Obstetrics and Gynecology, Pelvic Floor Research Group, University of Michigan, Ann Arbor, MI, USA
- Department of Biomedical Engineering, Pelvic Floor Research Group, University of Michigan, Ann Arbor, MI, USA
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16
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Powers SA, Burleson LK, Hannan JL. Managing female pelvic floor disorders: a medical device review and appraisal. Interface Focus 2019; 9:20190014. [PMID: 31263534 DOI: 10.1098/rsfs.2019.0014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/07/2019] [Indexed: 02/07/2023] Open
Abstract
Pelvic floor disorders (PFDs) will affect most women during their lifetime. Sequelae such as pelvic organ prolapse, stress urinary incontinence, chronic pain and dyspareunia significantly impact overall quality of life. Interventions to manage or eliminate symptoms from PFDs aim to restore support of the pelvic floor. Pessaries have been used to mechanically counteract PFDs for thousands of years, but do not offer a cure. By contrast, surgically implanted grafts or mesh offer patients a more permanent resolution but have been in wide use within the pelvis for less than 30 years. In this perspective review, we provide an overview of the main theories underpinning PFD pathogenesis and the animal models used to investigate it. We highlight the clinical outcomes of mesh and grafts before exploring studies performed to elucidate tissue level effects and bioengineering considerations. Considering recent turmoil surrounding transvaginal mesh, the role of pessaries, an impermanent method, is examined as a means to address patients with PFDs.
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Affiliation(s)
- Shelby A Powers
- Department of Physiology, Brody School of Medicine, East Carolina University, 600 Moye Boulevard, Mailstop 634, Greenville, NC 27834-4354, USA
| | - Lindsey K Burleson
- Department of Physiology, Brody School of Medicine, East Carolina University, 600 Moye Boulevard, Mailstop 634, Greenville, NC 27834-4354, USA
| | - Johanna L Hannan
- Department of Physiology, Brody School of Medicine, East Carolina University, 600 Moye Boulevard, Mailstop 634, Greenville, NC 27834-4354, USA
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CHANDA ARNAB, FLYNN ZACHARY, UNNIKRISHNAN VINU. BIOMECHANICAL CHARACTERIZATION OF NORMAL AND PROLAPSED VAGINAL TISSUE SURROGATES. J MECH MED BIOL 2018. [DOI: 10.1142/s0219519417501007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
In the recent years, poorly evaluated gynecological surgeries and urogynecological mesh implantations have been affecting millions of women in the US and across the globe. These failed surgeries could be mainly attributed to the nonavailability of vaginal tissues (due to ethical and biosafety issues), which does not allow any experimental testing of operation and mesh implantation techniques before an actual surgery. A surrogate which behaves biomechanically like the human vaginal tissue would be indispensable for simulating surgical suture of vaginal tissues in prolapse surgery, hysterectomy or surgery during traumatic child births (such as Cesarean). Also, vaginal tissue surrogates simulating the various prolapse conditions (such as vaginal tissue stiffening) would be very useful to evaluate tissue modifications due to prolapse, and also mesh and vaginal tissue interactions. In the current work, a low cost four-part silicone-based material was developed, which precisely simulates the linear and nonlinear mechanical behavior of the normal human vaginal tissue. Additionally, a range of four-part silicone-based novel materials were developed which precisely mimics the mechanical behavior of stiffened vaginal tissues at different degrees of prolapse. The linear and nonlinear mechanical behavior of all such novel materials were characterized using elastic and hyperelastic formulations. Such precisely characterized normal and prolapsed vaginal tissue surrogates have not been developed anywhere to date as per the best of our knowledge and would be clinically helpful for gynecological surgical planning in the future.
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Affiliation(s)
- ARNAB CHANDA
- Department of Aerospace Engineering and Mechanics, University of Alabama, Tuscaloosa 35487, USA
| | - ZACHARY FLYNN
- Department of Mechanical Engineering, University of Alabama, Tuscaloosa 35487, USA
| | - VINU UNNIKRISHNAN
- Department of Aerospace Engineering and Mechanics, University of Alabama, Tuscaloosa 35487, USA
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18
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Wang S, Lü D, Zhang Z, Jia X, Yang L. Effects of mechanical stretching on the morphology of extracellular polymers and the mRNA expression of collagens and small leucine-rich repeat proteoglycans in vaginal fibroblasts from women with pelvic organ prolapse. PLoS One 2018; 13:e0193456. [PMID: 29630675 PMCID: PMC5890965 DOI: 10.1371/journal.pone.0193456] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 02/12/2018] [Indexed: 01/12/2023] Open
Abstract
To determine the effect of mechanical stretching load and the efficacy of postmenopausal estrogen therapy (ET) on pelvic organ prolapse (POP), vaginal fibroblasts isolated from postmenopausal women with or without POP were subjected to 0.1-Hz uniaxial cyclic mechanical stretching (CS) with 10% elongation and 10-8 M 17-β-estradiol (E2) treatment. We investigated the morphological characteristics of extracellular polymers using scanning electron microscopy (SEM) and monitored the mRNA expression of type I collagen (COL I) and type III collagen (COL III) as well as the small leucine-rich proteoglycan (SLRP) family members decorin (DCN), biglycan (BGN), fibromodulin (FMO), and lumican (LUM), using real-time quantitative polymerase chain reaction (RT-PCR). Using SEM, certain viscoelastic polymers were found to be randomly distributed among fibroblasts, which for normal fibroblasts formed clusters of plum flower-like patterns under static-culture conditions and resembled stretched strips when stretched in culture, whereas polymers among POP fibroblasts resembled stretched strips under static-cultured conditions and presented broken networks when stretched in culture. RT-PCR revealed that COL I, DCN, BGN, FMO, and LUM mRNA expression was significantly higher in POP than in normal fibroblasts under static-culture condition. Following CS, COL I and BGN mRNA expression was significantly up-regulated in normal fibroblasts, and DCN and FMO mRNA expression was down-regulated in POP fibroblasts. Following concomitant CS and E2 treatment, significantly elevated COL I and DCN mRNA expression was observed in normal fibroblasts, and significantly elevated COL I and BGN mRNA expression was observed in POP fibroblasts. COL III mRNA expression was not significantly different between the POP and normal group, and CS did not significantly affect expression in either group, though COL III was down-regulated in normal fibroblasts concomitantly treated with E2 and CS. We conclude that the morphological distribution of extracellular polymers in POP fibroblasts exhibited higher sensitivity and lower tolerance to stretching loads than do normal fibroblasts. These mechanical properties were further reflected in the transcription of COL I. Defects in the compensatory function of BGN for DCN and LUM for FMO exist in POP fibroblasts, which further affect the structure and function of COL I in response to stretching load, ultimately resulting in abnormal reconstruction of pelvic supportive connective tissues and the occurrence of POP. ET can maintain stretching-induced elevations in COL I and DCN transcription in healthy women and improve stretching-induced COL I, DCN, BGN, and FMO transcriptional changes in POP women to prevent and improve POP. Only down-regulated COL III transcription was observed upon concomitant CS and E2 treatment in normal fibroblasts, which suggests that the tensile strength, not the elasticity, of the supportive connective tissues is damaged in POP and that the higher tensile strength induced by ET in healthy fibroblasts prevents POP. These findings confirm the role of higher sensitivity and lower tolerance to mechanical stretching in the pathogenesis of POP and further provide evidence supporting the use of ET to prevent and inhibit POP in postmenopausal women.
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Affiliation(s)
- Sumei Wang
- Department of Obstetrics and Gynecology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
- * E-mail: (ZZ); (SW); (XJ)
| | - Dongyuan Lü
- Center for Biomechanics and Bioengineering, Key Laboratory of Microgravity (National Microgravity Laboratory) and Beijing Key Laboratory of Engineered Construction and Mechanobiology, Institute of Mechanics, Chinese Academy of Sciences, Beijing, China
| | - Zhenyu Zhang
- Department of Obstetrics and Gynecology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
- * E-mail: (ZZ); (SW); (XJ)
| | - Xingyuan Jia
- Medical Research Center, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
- * E-mail: (ZZ); (SW); (XJ)
| | - Lei Yang
- Medical Research Center, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
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19
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Ruiz-Zapata AM, Feola AJ, Heesakkers J, de Graaf P, Blaganje M, Sievert KD. Biomechanical Properties of the Pelvic Floor and its Relation to Pelvic Floor Disorders. ACTA ACUST UNITED AC 2018. [DOI: 10.1016/j.eursup.2017.12.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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20
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Silva M, Parente M, Brandão S, Mascarenhas T, Natal Jorge R. Characterization of the passive and active material parameters of the pubovisceralis muscle using an inverse numerical method. J Biomech 2018; 71:100-110. [DOI: 10.1016/j.jbiomech.2018.01.033] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 12/11/2017] [Accepted: 01/28/2018] [Indexed: 12/28/2022]
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21
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SILVA MET, BRANDÃO S, PARENTE MPL, MASCARENHAS T, NATAL JORGE RM. THE INFLUENCE OF PELVIC ORGAN PROLAPSE ON THE PASSIVE BIOMECHANICAL PROPERTIES OF PELVIC FLOOR MUSCLES. J MECH MED BIOL 2017. [DOI: 10.1142/s0219519417500907] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The biomechanical properties of the female pelvic floor tissues, such as muscles, fascia or ligaments are relevant when explaining pelvic disorders, since these may result from changes in the properties of those tissues. The aim of this study is to understand the influence of pelvic organ prolapse (POP) on the passive biomechanical properties of the pelvic floor muscles. For this purpose, magnetic resonance images at Valsalva maneuver were used, and an inverse finite element analysis technique was applied. The numerical models of the pubovisceralis muscle and pelvic bones were built from axial magnetic resonance images acquired at rest. The numerical simulation was based on the finite element method (FEM), by which the material constants were determined for three different constitutive models (Neo-Hookean, Mooney–Rivlin and Yeoh). The ratio between the values of the material constants for women with and without prolapse was approximately 43% for the parameter [Formula: see text] in the Neo-Hookean constitutive model, 57% and 24% for [Formula: see text] and [Formula: see text] in the Mooney–Rivlin constitutive model, and 35%, 21% and 14% for [Formula: see text], [Formula: see text] and [Formula: see text] in the Yeoh constitutive model. For the three constitutive models, the mean values of the material properties related with stiffness were higher for the muscles of women with POP. These increases in stiffness are in line with other experimental works involving vaginal tissue, which showing that the elasticity module is significantly higher in the prolapsed tissue when compared with normal tissue. The present work presents a noninvasive methodology based on the application of the FEM, which allows the establishment of a relationship between the stiffness of the pelvic floor muscles of women with POP and without this pathology.
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Affiliation(s)
- M. E. T. SILVA
- LAETA, INEGI, Faculty of Engineering, University of Porto, Rua Dr. Roberto Frias, 4200-465 Porto, Portugal
| | - S. BRANDÃO
- LAETA, INEGI, Faculty of Engineering, University of Porto, Rua Dr. Roberto Frias, 4200-465 Porto, Portugal
- Department of Radiology, Centro Hospitalar de São João-EPE, Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
| | - M. P. L. PARENTE
- LAETA, INEGI, Faculty of Engineering, University of Porto, Rua Dr. Roberto Frias, 4200-465 Porto, Portugal
| | - T. MASCARENHAS
- Department of Gynecology and Obstetrics, Centro Hospitalar de São João-EPE, Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
| | - R. M. NATAL JORGE
- LAETA, INEGI, Faculty of Engineering, University of Porto, Rua Dr. Roberto Frias, 4200-465 Porto, Portugal
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22
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Liang R, Knight K, Easley D, Palcsey S, Abramowitch S, Moalli PA. Towards rebuilding vaginal support utilizing an extracellular matrix bioscaffold. Acta Biomater 2017; 57:324-333. [PMID: 28487243 PMCID: PMC5639927 DOI: 10.1016/j.actbio.2017.05.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Revised: 04/25/2017] [Accepted: 05/05/2017] [Indexed: 12/15/2022]
Abstract
As an alternative to polypropylene mesh, we explored an extracellular matrix (ECM) bioscaffold derived from urinary bladder matrix (MatriStem™) in the repair of vaginal prolapse. We aimed to restore disrupted vaginal support simulating application via transvaginal and transabdominal approaches in a macaque model focusing on the impact on vaginal structure, function, and the host immune response. In 16 macaques, after laparotomy, the uterosacral ligaments and paravaginal attachments to pelvic side wall were completely transected (IACUC# 13081928). 6-ply MatriStem was cut into posterior and anterior templates with a portion covering the vagina and arms simulating uterosacral ligaments and paravaginal attachments, respectively. After surgically exposing the correct anatomical sites, in 8 animals, a vaginal incision was made on the anterior and posterior vagina and the respective scaffolds were passed into the vagina via these incisions (transvaginal insertion) prior to placement. The remaining 8 animals underwent the same surgery without vaginal incisions (transabdominal insertion). Three months post implantation, firm tissue bands extending from vagina to pelvic side wall appeared in both MatriStem groups. Experimental endpoints examining impact of MatriStem on the vagina demonstrated that vaginal biochemical and biomechanical parameters, smooth muscle thickness and contractility, and immune responses were similar in the MatriStem no incision group and sham-operated controls. In the MatriStem incision group, a 41% decrease in vaginal stiffness (P=0.042), a 22% decrease in collagen content (P=0.008) and a 25% increase in collagen subtypes III/I was observed vs. Sham. Active MMP2 was increased in both Matristem groups vs. Sham (both P=0.002). This study presents a novel application of ECM bioscaffolds as a first step towards the rebuilding of vaginal support. STATEMENT OF SIGNIFICANCE Pelvic organ prolapse is a common condition related to failure of the supportive soft tissues of the vagina; particularly at the apex and mid-vagina. Few studies have investigated methods to regenerate these failed structures. The overall goal of the study was to determine the feasibility of utilizing a regenerative bioscaffold in prolapse applications to restore apical (level I) and lateral (level II) support to the vagina without negatively impacting vaginal structure and function. The significance of our findings is two fold: 1. Implantation of properly constructed extracellular matrix grafts promoted rebuilding of level I and level II support to the vagina and did not negatively impact the overall functional, morphological and biochemical properties of the vagina. 2. The presence of vaginal incisions in the transvaginal insertion of bioscaffolds may compromise vaginal structural integrity in the short term.
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Affiliation(s)
- Rui Liang
- Magee Women Research Institute, University of Pittsburgh, Pittsburgh, PA, USA; Department of Obstetrics, Gynecology, Reproductive Sciences, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Katrina Knight
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Deanna Easley
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Stacy Palcsey
- Magee Women Research Institute, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Steven Abramowitch
- Magee Women Research Institute, University of Pittsburgh, Pittsburgh, PA, USA; Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Pamela A Moalli
- Magee Women Research Institute, University of Pittsburgh, Pittsburgh, PA, USA; Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA; Department of Obstetrics, Gynecology, Reproductive Sciences, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
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23
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Biomechanical and morphological properties of the multiparous ovine vagina and effect of subsequent pregnancy. J Biomech 2017; 57:94-102. [DOI: 10.1016/j.jbiomech.2017.03.023] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 02/22/2017] [Accepted: 03/31/2017] [Indexed: 11/17/2022]
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24
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Emmerson S, Young N, Rosamilia A, Parkinson L, Edwards SL, Vashi AV, Davies-Tuck M, White J, Elgass K, Lo C, Arkwright J, Werkmeister JA, Gargett CE. Ovine multiparity is associated with diminished vaginal muscularis, increased elastic fibres and vaginal wall weakness: implication for pelvic organ prolapse. Sci Rep 2017; 7:45709. [PMID: 28374826 PMCID: PMC5379562 DOI: 10.1038/srep45709] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 03/03/2017] [Indexed: 12/26/2022] Open
Abstract
Pelvic Organ Prolapse (POP) is a major clinical burden affecting 25% of women, with vaginal delivery a major contributing factor. We hypothesised that increasing parity weakens the vagina by altering the extracellular matrix proteins and smooth muscle thereby leading to POP vulnerability. We used a modified POP-quantification (POP-Q) system and a novel pressure sensor to measure vaginal wall weakness in nulliparous, primiparous and multiparous ewes. These measurements were correlated with histological, biochemical and biomechanical properties of the ovine vagina. Primiparous and multiparous ewes had greater displacement of vaginal tissue compared to nulliparous at points Aa, Ap and Ba and lower pressure sensor measurements at points equivalent to Ap and Ba. Vaginal wall muscularis of multiparous ewes was thinner than nulliparous and had greater elastic fibre content. Collagen content was lower in primiparous than nulliparous ewes, but collagen organisation did not differ. Biomechanically, multiparous vaginal tissue was weaker and less stiff than nulliparous. Parity had a significant impact on the structure and function of the ovine vaginal wall, as the multiparous vaginal wall was weaker and had a thinner muscularis than nulliparous ewes. This correlated with "POP-Q" and pressure sensor measurements showing greater tissue laxity in multiparous compared to nulliparous ewes.
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Affiliation(s)
- Stuart Emmerson
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, 3168, Australia.,Monash University, Department of Obstetrics and Gynaecology, Clayton, Victoria, 3168, Australia
| | | | - Anna Rosamilia
- Monash University, Department of Obstetrics and Gynaecology, Clayton, Victoria, 3168, Australia.,Monash Health, Clayton, Victoria, 3168, Australia
| | - Luke Parkinson
- School of Computer Science, Engineering and Mathematics, Flinders University, Bedford Park, South Australia 5042, Australia
| | | | | | - Miranda Davies-Tuck
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, 3168, Australia.,Monash University, Department of Obstetrics and Gynaecology, Clayton, Victoria, 3168, Australia
| | - Jacinta White
- CSIRO Manufacturing, Clayton, Victoria, 3168, Australia
| | - Kirstin Elgass
- MicroImaging, Hudson Institute of Medical Research, Clayton, Victoria, 3168, Australia
| | - Camden Lo
- MicroImaging, Hudson Institute of Medical Research, Clayton, Victoria, 3168, Australia
| | - John Arkwright
- School of Computer Science, Engineering and Mathematics, Flinders University, Bedford Park, South Australia 5042, Australia
| | - Jerome A Werkmeister
- Monash University, Department of Obstetrics and Gynaecology, Clayton, Victoria, 3168, Australia.,CSIRO Manufacturing, Clayton, Victoria, 3168, Australia
| | - Caroline E Gargett
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, 3168, Australia.,Monash University, Department of Obstetrics and Gynaecology, Clayton, Victoria, 3168, Australia
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25
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Silva MET, Brandão S, Parente MPL, Mascarenhas T, Natal Jorge RM. Biomechanical properties of the pelvic floor muscles of continent and incontinent women using an inverse finite element analysis. Comput Methods Biomech Biomed Engin 2017; 20:842-852. [DOI: 10.1080/10255842.2017.1304542] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Chanda A, Unnikrishnan V, Richter HE, Lockhart ME. A biofidelic computational model of the female pelvic system to understand effect of bladder fill and progressive vaginal tissue stiffening due to prolapse on anterior vaginal wall. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2016; 32:e02767. [PMID: 26732347 DOI: 10.1002/cnm.2767] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Revised: 12/23/2015] [Accepted: 12/27/2015] [Indexed: 06/05/2023]
Abstract
Treatment of anterior vaginal prolapse (AVP), suffered by over 500,000 women in the USA, is a challenge in urogynecology because of the poorly understood mechanics of AVP. Recently, computational modeling combined with finite element method has been used to model AVP through the study of pelvic floor muscle and connective tissue impairments on the anterior vaginal wall (AVW). Also, the effects of pelvic organ displacements on the AVW were studied numerically. In our current work, an MRI-based full-scale biofidelic computational model of the female pelvic system composed of the urinary bladder, vaginal canal, and the uterus was developed, and a novel finite element method framework was employed to simulate vaginal tissue stiffening and also bladder filling due to expansion for the first time. A mesh convergence study was conducted to choose a computationally efficient mesh, and a non-linear hyperelastic Yeoh's material model was adopted for the study. The AVW displacements, mechanical stresses, and strains were estimated at varying degrees of bladder fills and vaginal tissue stiffening. Both bladder filling and vaginal stiffening were found to increase the stress concentration on the AVW with varying trends, which have been discussed in detail in the paper. To our knowledge, this study is the first to estimate the individual and combined effects of bladder filling and vaginal tissue stiffening due to prolapse on the AVW. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Arnab Chanda
- Department of Aerospace Engineering and Mechanics, University of Alabama, Tuscaloosa, 35487, AL, USA
| | - Vinu Unnikrishnan
- Department of Aerospace Engineering and Mechanics, University of Alabama, Tuscaloosa, 35487, AL, USA.
| | - Holly E Richter
- Division of Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, 1720 2nd Ave S, Birmingham, AL, 35233, USA
| | - Mark E Lockhart
- Department of Radiology, University of Alabama at Birmingham, 1720 2nd Ave S, Birmingham, AL, 35233, USA
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Vaginal Fibroblastic Cells from Women with Pelvic Organ Prolapse Produce Matrices with Increased Stiffness and Collagen Content. Sci Rep 2016; 6:22971. [PMID: 26965792 PMCID: PMC4786799 DOI: 10.1038/srep22971] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 02/22/2016] [Indexed: 02/08/2023] Open
Abstract
Pelvic organ prolapse (POP) is characterised by the weakening of the pelvic floor support tissues, and often by subsequent prolapse of the bladder outside the body, i.e. cystocele. The bladder is kept in place by the anterior vaginal wall which consists of a dense extracellular matrix rich in collagen content that is maintained and remodelled by fibroblastic cells, i.e. fibroblasts and myofibroblasts. Since altered matrix production influences tissue quality, and myofibroblasts are involved in normal and pathological soft tissue repair processes, we evaluated matrix production of cells derived from pre- and post-menopausal POP and non-POP control anterior vaginal wall tissues. Results showed that cells from postmenopausal POP women deposited matrices with high percentage of collagen fibres with less anisotropic orientation and increased stiffness than those produced by controls. There was a transient increase in myofibroblastic phenotype that was lost after the peak of tissue remodelling. In conclusion, affected fibroblasts from postmenopausal prolapsed tissues produced altered matrices in vitro compared to controls. Such aberrant altered matrix production does not appear to be a consequence of abnormal phenotypical changes towards the myofibroblastic lineage.
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van der Walt S, Oettlé AC, van Wijk FJ. The Pudendal Nerve and Its Branches in Relation to Richter's Procedure. Gynecol Obstet Invest 2015; 81:275-9. [PMID: 26227418 DOI: 10.1159/000435878] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Accepted: 06/11/2015] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Variations in the branching pattern of the pudendal nerve (PN) have been described in the literature. This study investigated these variations in order to comment on a safe area for the placement of a Richter's stitch. METHODS Richter's procedure was performed on nine unembalmed female cadavers and followed by dissection. PN dissections were done on another 20 embalmed female cadavers. Variations in the branching pattern of the PN were noted and the distance between the Richter's stitch placed and the PN/or the inferior rectal nerve (IRN) measured. RESULTS The IRN entered the gluteal region as a separate structure in 6/29 cases. The separate IRN was found to pass between 4.1 and 14.45 mm medial to the ischial spine in 18/29 cases. In one case, the Richter's stitch was found to pierce the IRN. The distance between the stitch and the PN and/or the IRN ranged from 0 to 17.8 mm. CONCLUSIONS To minimize the risk of nerve damage or entrapment, the Richter's stitch should be placed >20 mm from the ischial spine. This recommended area should be revised for different population groups, as variations might exist between groups.
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Affiliation(s)
- Sonè van der Walt
- Department of Anatomy, School of Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
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Banas T, Pitynski K, Jach R, Knafel A, Ludwin A, Juszczyk G, Nieweglowska D. Primary Vulvo-Vaginal Cancers: Trends in Incidence and Mortality in Poland (1999-2012). Gynecol Obstet Invest 2015; 80:240-5. [PMID: 26065364 DOI: 10.1159/000381770] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Accepted: 03/18/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND The aim of this study was to determine the incidence, mortality rates and trends of vulvar and vaginal cancers in Poland. METHODS Data were retrieved from the Polish National Cancer Registry. Age-standardised rates (ASRs) of cancer incidence and mortality were calculated by direct standardisation, and joinpoint regression was performed to describe the trends using the average annual percent change (AAPC). RESULTS From 1999 to 2012, the number of diagnosed cases of vulvar cancer was 5,958, and the ASRs of incidence varied from 0.99 to 1.18, with a significant trend towards a decrease (AAPC -0.78; p < 0.05). The ASR of mortality varied from 0.39 to 0.62, with a slight but insignificant increase in trend (AAPC 0.72; p > 0.05). The ASR of vaginal cancer incidence varied from 0.21 to 0.31, while the ASR of mortality ranged from 0.09 to 0.22. This study also proved a significantly falling trend in vaginal cancer mortality (AAPC -4.69; p < 0.05) and a decreasing trend in vaginal cancer incidence (AAPC -1.67; p > 0.05). CONCLUSION The rarity of vulvar and vaginal cancers as well as the decline in their incidence rates should not discourage further research on the epidemiology and treatment of these conditions.
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Affiliation(s)
- Tomasz Banas
- Department of Gynecology and Oncology, Jagiellonian University Medical College, Krakow, Poland
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Effects of mechanical stretching on the morphology and cytoskeleton of vaginal fibroblasts from women with pelvic organ prolapse. Int J Mol Sci 2015; 16:9406-19. [PMID: 25923074 PMCID: PMC4463595 DOI: 10.3390/ijms16059406] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2014] [Revised: 03/04/2015] [Accepted: 04/08/2015] [Indexed: 01/03/2023] Open
Abstract
Mechanical load and postmenopausal hypoestrogen are risk factors for pelvic organ prolapse (POP). In this study, we applied a 0.1-Hz uniaxial cyclic mechanical stretching (CS) with 10% elongation and 10−8 M 17-β-estradiol to vaginal fibroblasts isolated from postmenopausal women with or without POP to investigate the effects of CS and estrogen on cell morphology and cytoskeletons of normal and POP fibroblasts. Under static culture condition, POP fibroblasts exhibited lower cell circularity and higher relative fluorescence intensities (RFIs) of F-actin, α-tubulin and vimentin. When cultured with CS, all fibroblasts grew perpendicular to the force and exhibited a decreased cell projection area, cell circularity and increased cell length/width ratio; normal fibroblasts exhibited increased RFIs of all three types of cytoskeleton, and POP fibroblasts exhibited a decreased RFI of F-actin and no significant differences of α-tubulin and vimentin. After being cultured with 17-β-estradiol and CS, normal fibroblasts no longer exhibited significant changes in the cell projection area and the RFIs of F-actin and α-tubulin; POP fibroblasts exhibited no significant changes in cell circularity, length/width ratio and F-actin even with the increased RFIs of α-tubulin and vimentin. These findings suggest that POP fibroblasts have greater sensitivity to and lower tolerance for mechanical stretching, and estrogen can improve the prognosis.
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Genc M, Sivrikoz ON, Sahin N, Celik E, Turan GA, Guclu S. Does uterine prolapse alter endometrial cyclooxygenase 2 expression and promote the development of premalignant lesions? Gynecol Obstet Invest 2015; 80:119-23. [PMID: 25662613 DOI: 10.1159/000371348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Accepted: 12/03/2014] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the expression of cyclooxygenase 2 (COX-2) and its association with the development of premalignant lesions in gland structures of the endometrium in patients with uterine prolapse, a condition which exposes the uterus to mechanical and infectious stress. METHODS The study included 102 patients who underwent hysterectomy to correct grade 3-4 uterine prolapse and 105 patients who underwent hysterectomy for other causes. Endometrial gland structures underwent immunohistochemical staining and COX-2 expression was graded. Grades 0 and 1 represent low expression; grades 2 and 3 correspond to high levels of COX-2 expression. RESULTS The prevalence of grade 2-3 COX-2 expression was significantly higher in the endometrial gland structures of patients with prolapse and hyperplasia compared to the remaining patients (p = 0.014). Grade 0-1 COX-2 expression was significantly more common in the endometrial gland structures of patients without uterine prolapse or hyperplasia (p = 0.004). Among the patients without endometrial hyperplasia, COX-2 expression was elevated in the endometrial gland structures of those with uterine prolapse compared to those without prolapse. CONCLUSION Elevated COX-2 expression may explain the presence of unexpected premalignant lesions of the endometrium in patients with uterine prolapse.
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Affiliation(s)
- Mine Genc
- Department of Obstetrics and Gynecology, Sifa University School of Medicine, Izmir, Turkey
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Brocker KA, Lippus F, Alt CD, Hallscheidt P, Zsolt F, Soljanik I, Lenz F, Bock M, Sohn C. Magnetic Resonance-Visible Polypropylene Mesh for Pelvic Organ Prolapse Repair. Gynecol Obstet Invest 2014; 79:101-6. [PMID: 25531860 DOI: 10.1159/000366442] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Accepted: 08/06/2014] [Indexed: 11/19/2022]
Affiliation(s)
- Kerstin A Brocker
- Department of Obstetrics and Gynecology, University Hospital Heidelberg, Heidelberg, Germany
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Noé GK, Anapolski M, Soltész S, Spüntrup C, Mettler L, Schollmeyer T, Alkatout I. Value of clinical and laboratory inflammation factors in the postoperative period after laparoscopic urogynecological surgery. Gynecol Obstet Invest 2014; 79:57-61. [PMID: 25115213 DOI: 10.1159/000364868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Accepted: 05/27/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS Leukocytes and C-reactive protein (CRP) levels are often used to detect infections. The aim of this study was to evaluate the diagnostic and screening validity of leukocytes and CRP levels as well as body temperature >38° C to predict infections after laparoscopic sacrocolpopexy. METHODS The study included 287 patients suffering from genital prolapse higher than POP-Q I. In addition to the sacrocolpopexy, a laparoscopic supracervical hysterectomy was performed in cases of preexisting uterus (n = 171). Leukocytes and CRP levels were analyzed preoperatively and 4 days after surgery. Early and late onset of infections was documented. RESULTS Urinary tract infection was identified as the most frequent early postoperative complication (11.4%). Early wound infections were found in 2.8% of the patients (8/287). Late onset of infections was found in 1% of patients (3/287). Areas under ROC curves were low for both leukocytes (0.52, 95% CI: 0.37-0.66) and CRP levels (0.60, 95% CI: 0.44-0.77). CONCLUSION Our findings question the benefit of routine determination of leukocytes and CRP levels 4 days after surgery. The sensitivity and specificity of leukocytes and CRP levels are probably more significant after normalization of the initial tissue response (days 8-10).
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Affiliation(s)
- Günter-Karl Noé
- KKH Dormagen, Academic Teaching Hospital of the University of Cologne, Dormagen, Germany
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