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Mechanical properties, pelvic organ prolapse

M E T Silva, M P L Parente, S Brandão, T Mascarenhas, R M Natal Jorge
The mechanical characteristics of the female pelvic floor are relevant to understand pelvic floor dysfunctions (PFD), and how they are related with changes in their biomechanical behavior. Urinary incontinence (UI) and pelvic organ prolapse (POP) are the most common pathologies, which can be associated with changes in the mechanical properties of the supportive structures in the female pelvic cavity. PFD have been studied through different methods, from experimental tensile tests using tissues from fresh female cadavers or tissues collected at the time of a transvaginal hysterectomy procedure, or by applying imaging techniques...
April 11, 2018: Journal of Biomechanics
Sarah Shafaat, Naside Mangir, Sabiniano R Regureos, Christopher R Chapple, Sheila MacNeil
AIMS: Pelvic organ prolapse and stress urinary incontinence affect 40-50% of postmenopausal women worldwide. Polypropylene meshes have been extensively used for the surgical intervention of these disorders; however, these meshes can lead to severe complications in some patients. The need for synthetic materials more suited for use in pelvic floor repair is widely accepted. This study aims to develop an electrospun 17-β-estradiol releasing polyurethane (PU) scaffold that not only provides the appropriate mechanical support but can also stimulate new extracellular matrix (ECM) production and angiogenesis...
February 2018: Neurourology and Urodynamics
Barbara Röhrnbauer, Cornelia Betschart, Daniele Perucchini, Michael Bajka, Daniel Fink, Caroline Maake, Edoardo Mazza, David Amos Scheiner
Little is known about the mechanical properties of pelvic floor structures and their role in the course and treatment of pelvic organ prolapse (POP). We hypothesize that in vivo mechanical properties of the vaginal wall are related to the appearance of POP and pre-and post-operative states. We used a suction device for intravaginal application, the aspiration device, to evaluate two in vivo mechanical parameters of the anterior vaginal wall, the load dependent tissue displacement and the initial displacement, by image analysis in pre- and post-menopausal women with (POP) and without (control) cystocele (POP: pre-menopausal: N = 6, post-menopausal: N = 19, control: pre-menopausal: N = 17, post-menopausal: N = 6)...
November 23, 2017: Scientific Reports
Mahshid Vashaghian, Sebastianus J Zaat, Theodoor H Smit, Jan-Paul Roovers
BACKGROUND: Polypropylene implants are used for the reconstructive surgery of urogynaecological disorders like pelvic organ prolapse, but severe complications associated with their use have been reported. There is evidence that surface properties and a difference in mechanical stiffness between the implant and the host tissue contribute to these adverse events. Electrospinning is an innovative engineering alternative that provides a biomimetic microstructure for implants, resulting in a different mechano-biological performance...
August 11, 2017: Neurourology and Urodynamics
Adwoa Baah-Dwomoh, Raffaella De Vita
The cardinal ligament (CL) is one of the major pelvic ligaments providing structural support to the vagina/cervix/uterus complex. This ligament has been studied mainly with regards to its important function in the treatment of different diseases such as surgical repair for pelvic organ prolapse and radical hysterectomy for cervical cancer. However, the mechanical properties of the CL have not been fully determined, despite the important in vivo supportive role of this ligament within the pelvic floor. To advance our limited knowledge about the elastic and viscoelastic properties of the CL, we conducted three consecutive planar equi-biaxial tests on CL specimens isolated from swine...
October 2017: Journal of the Mechanical Behavior of Biomedical Materials
Cecilie Glindtvad, Menglin Chen, Jens Vinge Nygaard, Lise Wogensen, Axel Forman, Carl Christian Danielsen, Mehmet Berat Taskin, Karl-Erik Andersson, Susanne Maigaard Axelsen
Half of the female population over age 50 years will experience pelvic organ prolapse. We suggest a new approach based on tissue engineering principles to functionally reconstruct the anatomical structures of the pelvic floor. The aim of this study is to investigate the mechanical performance and effect on collagen and elastin production of a degradable mesh releasing basic fibroblast growth factor (bFGF). Implantation of biodegradable mesh with or without bFGF in their core has been conducted in 40 rats in an abdominal wall defect model...
February 2018: Journal of Biomedical Materials Research. Part B, Applied Biomaterials
Deanna C Easley, Steven D Abramowitch, Pamela A Moalli
PURPOSE OF REVIEW: The pelvic floor is a complex assembly of connective tissues and striated muscles that simultaneously counteracts gravitational forces, inertial forces, and intra-abdominal pressures while maintaining the position of the pelvic organs. In 30% of women, injury or failure of the pelvic floor results in pelvic organ prolapse. Surgical treatments have high recurrence rates, due, in part, to a limited understanding of physiologic loading conditions. It is critical to apply biomechanics to help elucidate how altered loading conditions of the pelvis contribute to the development of pelvic organ prolapse and to define surgeries to restore normal support...
May 2017: Current Opinion in Urology
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)...
March 2017: 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
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