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Mechanical properties, pelvic organ prolapse

Xiani Yan, Jennifer A Kruger, Xinshan Li, Poul M F Nielsen, Martyn P Nash
Vaginal delivery is the primary cause of levator ani muscle injury, which is in turn the leading factor contributing to pelvic floor disorders including pelvic organ prolapse and urinary stress incontinence. Existing biomechanical models of childbirth have provided some understanding of pelvic floor function during delivery and have helped in the investigation of preventative strategies. The modeling frameworks for childbirth simulation are described with emphasis on (1) the recent advances in medical imaging quality and computational power; (2) improvements in the anatomical representation of the pelvic floor and fetal head; (3) more realistic boundary conditions for delivery; and (4) mechanical properties determined from experiments...
November 2016: Wiley Interdisciplinary Reviews. Systems Biology and Medicine
Rui Liang, Katrina Knight, Steve Abramowitch, Pamela A Moalli
PURPOSE OF REVIEW: Polypropylene mesh has been widely used in the surgical repair of pelvic organ prolapse. However, low but persistent rates of complications related to mesh, most commonly mesh exposure and pain, have hampered its use. Complications are higher following transvaginal implantation prompting the Food and Drug Administration to release two public health notifications warning of complications associated with transvaginal mesh use (PHN 2008 and 2011) and to upclassify transvaginal prolapse meshes from Class II to Class III devices...
October 2016: Current Opinion in Obstetrics & Gynecology
Zhuo Yang, Jaclyn Hayes, Sundar Krishnamurty, Ian R Grosse
OBJECTIVES: The purpose of this study is to develop a validated 3D finite element model of the pelvic floor system which can offer insights into the mechanics of anterior vaginal wall prolapse and have the ability to assess biomedical device treatment methods. The finite element results should accurately mimic the clinical findings of prolapse due to intra-abdominal pressure (IAP) and soft tissues impairment conditions. METHODS: A 3D model of pelvic system was created in Creo Parametric 2...
December 2016: Computer Methods in Biomechanics and Biomedical Engineering
William R Barone, Pamela A Moalli, Steven D Abramowitch
BACKGROUND: Although synthetic mesh is associated with superior anatomic outcomes for the repair of pelvic organ prolapse, the benefits of mesh have been questioned because of the relatively high complication rates. To date, the mechanisms that result in such complications are poorly understood, yet the textile characteristics of mesh products are believed to play an important role. Interestingly, the pore diameter of synthetic mesh has been shown to impact the host response after hernia repair greatly, and such findings have served as design criteria for prolapse meshes, with larger pores viewed as more favorable...
September 2016: American Journal of Obstetrics and Gynecology
Dandan Zhang, Zhi Yuan William Lin, Ruoyu Cheng, Wei Wu, Jia Yu, Xin Zhao, Xinliang Chen, Wenguo Cui
Numerous modifications have been developed over the past two decades seeking to improve the transvaginal repair in the pelvic organ prolapse (POP) by using polypropylene (PP) mesh implants. The hydrophobicity of PP, however, presents a great hindrance for translating potential technologies into viable clinical applications. In this study, by manipulating self-polymerization and strong adhesive characteristics of dopamine, we developed a facile method to enhance the transvaginal repair by modifying PP meshes with polydopamine (PDA), which allowed easy grafting of basic fibroblast growth factor (bFGF) onto the surface of PP...
June 1, 2016: Colloids and Surfaces. B, Biointerfaces
Katrina M Knight, Pamela A Moalli, Alexis Nolfi, Stacy Palcsey, William R Barone, Steven D Abramowitch
INTRODUCTION AND HYPOTHESIS: Parity is the leading risk factor for the development of pelvic organ prolapse. To assess the impact of pregnancy and delivery on vaginal tissue, researchers commonly use nonhuman primate (NHP) and rodent models. The purpose of this study was to evaluate the ewe as an alternative model by investigating the impact of parity on the ewe vaginal mechanical properties and collagen structure. METHODS: Mechanical properties of 15 nulliparous and parous ewe vaginas were determined via uniaxial tensile tests...
August 2016: International Urogynecology Journal
Mahshid Vashaghian, Alejandra M Ruiz-Zapata, Manon H Kerkhof, Behrouz Zandieh-Doulabi, Arie Werner, Jan Paul Roovers, Theo H Smit
OBJECTIVE: The use of knitted, polypropylene meshes for the surgical treatment of pelvic organ prolapse (POP) is frequently accompanied by severe complications. Looking for alternatives, we studied the potential of three different electrospun matrices in supporting the adhesion, proliferation, and matrix deposition of POP and non-POP fibroblasts, the most important cells to produce extracellular matrix (ECM), in vitro. STUDY DESIGN: We electrospun three commonly used medical materials: nylon; poly (lactide-co-glycolide) blended with poly-caprolactone (PLGA/PCL); and poly-caprolactone blended with gelatin (PCL/Gelatin)...
February 3, 2016: Neurourology and Urodynamics
Jing Ding, Mou Deng, Xiao-Chen Song, Chun Chen, Kui-Lin Lai, Guo-Shuai Wang, Yu-Yu Yuan, Tao Xu, Lan Zhu
BACKGROUND: Implantation of nonabsorbable polypropylene (PP) mesh in the vagina is the main surgical treatment for pelvic organ prolapse (POP); however, clinical outcomes remain controversial and far from satisfactory. In particular, reducing the exposure or erosion of vaginal implants to obtain improved functional reconstruction is challenging. There is an urgent need for the development of new materials and/or products for POP treatment. A nanofibrous biomimetic mesh was recently developed to address this issue...
August 2016: Journal of the Mechanical Behavior of Biomedical Materials
Liangpeng Ge, Lubin Liu, Haoche Wei, Lei Du, Shixuan Chen, Yong Huang, Renshu Huang
Pelvic organ prolapse (POP) is a serious health issue that affects many adult women. Surgical treatments for POP patients comprise a common strategy in which scaffold materials are used to reconstruct the prolapsed pelvic. However, the existing materials for pelvic reconstruction cannot meet clinical requirements in terms of biocompatibility, mechanics and immunological rejection. To address these concerns, polypropylene (PP) mesh was selected because of its strong mechanical properties. Small intestinal submucosa (SIS) was used to modify the PP mesh via a mussel-inspired polydopamine coating to enhance its biocompatibility...
April 2016: Journal of Biomaterials Applications
Laurent de Landsheere, Mathias Brieu, Silvia Blacher, Carine Munaut, Betty Nusgens, Chrystèle Rubod, Agnès Noel, Jean-Michel Foidart, Michelle Nisolle, Michel Cosson
INTRODUCTION AND HYPOTHESIS: The aim of the study was to correlate histological and biomechanical characteristics of the vaginal wall in women with pelvic organ prolapse (POP). METHODS: Tissue samples were collected from the anterior [point Ba; POP Questionnaire (POP-Q)] and/or posterior (point Bp; POP-Q) vaginal wall of 15 women who underwent vaginal surgery for POP. Both histological and biomechanical assessments were performed from the same tissue samples in 14 of 15 patients...
April 2016: International Urogynecology Journal
S Todros, P G Pavan, A N Natali
Synthetic meshes are widely used for surgical repair of different kind of prolapses. In the light of the experience of abdominal wall repair, similar prostheses are currently used in the pelvic region, to restore physiological anatomy after organ prolapse into the vaginal wall, that represent a recurrent dysfunction. For this purpose, synthetic meshes are surgically positioned in contact with the anterior and/or posterior vaginal wall, to inferiorly support prolapsed organs. Nonetheless, while mesh implantation restores physiological anatomy, it is often associated with different complications in the vaginal region...
March 2015: Journal of the Mechanical Behavior of Biomedical Materials
Miguel Angel Bigozzi, Sergio Provenzano, Fernando Maeda, Paulo Palma, Cassio Riccetto
AIMS: This work evaluated the post-implant biomechanical properties of light-weight (LW) and heavy-weight (HW) monofilament polypropylene (PP) meshes with different knitting patterns in an animal model in vivo. METHODS: Forty-five adult female Wistar rats were divided into three groups and randomly implanted with 32 × 32 mm HW-PP (62 gm(-2) ) orLW-PP (16 gm(-2) ) in the lower abdomen. LW-PPwas tested orthogonally (called LWL and LWT) to reproduce the longitudinal and transverse planes of the vaginal wall, respectively...
January 2017: Neurourology and Urodynamics
Rui Liang, Katrina Knight, Alexis Nolfi, Steven Abramowitch, Pamela A Moalli
OBJECTIVE: Some selective estrogen receptor modulators (SERMs) have been associated with increased incidence of urinary incontinence and pelvic organ prolapse. This study explored the effects of five SERMs on the function and matrix components of the vagina and its supportive tissues. METHODS: Fifty-six rats were administered SERMs by oral gavage for 8 weeks (n = 8 for each SERM): raloxifene, tamoxifen, idoxifene, bazedoxifene at three different doses, and bazedoxifene with conjugated estrogens...
February 2016: Menopause: the Journal of the North American Menopause Society
Daniela Ulrich, Sharon L Edwards, David L J Alexander, Anna Rosamilia, Jerome A Werkmeister, Caroline E Gargett, Vincent Letouzey
BACKGROUND: Pelvic organ prolapse (POP) is a multifactorial disease that manifests as the herniation of the pelvic organs into the vagina. Surgical methods for prolapse repair involve the use of a synthetic polypropylene mesh. The use of this mesh has led to significantly higher anatomical success rates compared with native tissue repairs, and therefore, despite recent warnings by the Food and Drug Administration regarding the use of vaginal mesh, the number of POP mesh surgeries has increased over the last few years...
February 2016: American Journal of Obstetrics and Gynecology
Géry Lamblin, Emmanuel Delorme, Michel Cosson, Chrystèle Rubod
INTRODUCTION AND HYPOTHESIS: We updated anatomic theories of pelvic organ support to determine pathophysiology in various forms of cystocele. METHODS: PubMed/MEDLINE, ScienceDirect, Cochrane Library, and Web of Science databases were searched using the terms pelvic floor, cystocele, anatomy, connective tissue, endopelvic fascia, and pelvic mobility. We retrieved 612 articles, of which 61 matched our topic and thus were selected. Anatomic structures of bladder support and their roles in cystocele onset were determined on the international anatomic classification; the various anatomic theories of pelvic organ support were reviewed and a synthesis was made of theories of cystocele pathophysiology...
September 2016: International Urogynecology Journal
Z Jallah, R Liang, A Feola, W Barone, S Palcsey, S D Abramowitch, N Yoshimura, P Moalli
OBJECTIVE: To evaluate the impact of prolapse meshes on vaginal smooth muscle structure (VaSM) and function, and to evaluate these outcomes in the context of the mechanical and textile properties of the mesh. DESIGN: Three months following the implantation of three polypropylene prolapse meshes with distinct textile and mechanical properties, mesh tissue explants were evaluated for smooth muscle contraction, innervation, receptor function, and innervation density...
June 2016: BJOG: An International Journal of Obstetrics and Gynaecology
Giulia Gigliobianco, Sabiniano Roman Regueros, Nadir I Osman, Julio Bissoli, Anthony J Bullock, Chris R Chapple, Sheila MacNeil
Stress urinary incontinence (SUI) and pelvic organ prolapse (POP) are major health issues that detrimentally impact the quality of life of millions of women worldwide. Surgical repair is an effective and durable treatment for both conditions. Over the past two decades there has been a trend to enforce or reinforce repairs with synthetic and biological materials. The determinants of surgical outcome are many, encompassing the physical and mechanical properties of the material used, and individual immune responses, as well surgical and constitutional factors...
2015: BioMed Research International
Jiajia Luo, Luyun Chen, Dee E Fenner, James A Ashton-Miller, John O L DeLancey
We developed a subject-specific 3-D finite element model to understand the mechanics underlying formation of female pelvic organ prolapse, specifically a rectocele and its interaction with a cystocele. The model was created from MRI 3-D geometry of a healthy 45 year-old multiparous woman. It included anterior and posterior vaginal walls, levator ani muscle, cardinal and uterosacral ligaments, anterior and posterior arcus tendineus fascia pelvis, arcus tendineus levator ani, perineal body, perineal membrane and anal sphincter...
June 25, 2015: Journal of Biomechanics
Svetlana L Kotova, Peter S Timashev, Anna E Guller, Anatoly B Shekhter, Pavel I Misurkin, Victor N Bagratashvili, Anna B Solovieva
We used atomic force microscopy (AFM) to diagnose pathological changes in the extracellular matrix (ECM) of skin connective tissue in patients with pelvic organ prolapse (POP). POP is a common condition affecting women that considerably decreases the patients' quality of life. Deviations from normal morphology of the skin ECM from patients with POP occur including packing and arrangement of individual collagen fibers and arrangement of collagen fibrils. The nanoindentation study revealed significant deterioration of the mechanical properties of collagen fibril bundles in the skin of POP patients as compared with the skin of healthy subjects...
April 2015: Microscopy and Microanalysis
S L Edwards, D Ulrich, J F White, K Su, A Rosamilia, J A M Ramshaw, C E Gargett, J A Werkmeister
Use of synthetic clinical meshes in pelvic organ prolapse (POP) repair can lead to poor mechanical compliance in vivo, as a result of a foreign body reaction leading to excessive scar tissue formation. Seeding mesh with mesenchymal stem cells (MSCs) prior to implantation may reduce the foreign body reaction and lead to improved biomechanical properties of the mesh-tissue complex. This study investigates the influence of seeding human endometrial mesenchymal stem cells (eMSCs) on novel gelatin-coated polyamide scaffolds, to identify differences in scaffold/tissue biomechanical properties and new tissue growth following up to 90 days' implantation, in a subcutaneous rat model of wound repair...
February 2015: Acta Biomaterialia
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