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Assessment of urethral support using MRI-derived computational modeling of the female pelvis

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Abstract

Introduction and hypothesis

This study aimed to assess the role of individual anatomical structures and their combinations to urethral support function.

Methods

A realistic pelvic model was developed from an asymptomatic female patient’s magnetic resonance (MR) images for dynamic biomechanical analysis using the finite element method. Validation was performed by comparing simulation results with dynamic MR imaging observations. Weaknesses of anatomical support structures were simulated by reducing their material stiffness. Urethral mobility was quantified by examining urethral axis excursion from rest to the final state (intra-abdominal pressure = 100 cmH2O). Seven individual support structures and five of their combinations were studied.

Result

Among seven urethral support structures, we found that weakening the vaginal walls, puborectalis muscle, and pubococcygeus muscle generated the top three largest urethral excursion angles. A linear relationship was found between urethral axis excursions and intra-abdominal pressure. Weakening all three levator ani components together caused a larger weakening effect than the sum of each individually weakened component, indicating a nonlinearly additive pattern. The pelvic floor responded to different weakening conditions distinctly: weakening the vaginal wall developed urethral mobility through the collapsed vaginal canal, while weakening the levator ani showed a more uniform pelvic floor deformation.

Conclusions

The computational modeling and dynamic biomechanical analysis provides a powerful tool to better understand the dynamics of the female pelvis under pressure events. The vaginal walls, puborectalis, and pubococcygeus are the most important individual structures in providing urethral support. The levator ani muscle group provides urethral support in a well-coordinated way with a nonlinearly additive pattern.

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References

  1. Delancey JOL (1994) Structural support of the urethra as it relates to stress urinary-incontinence—the hammock hypothesis. Am J Obstet Gynecol 170(6):1713–1723

    Article  CAS  PubMed  Google Scholar 

  2. Sendag F, Vidinli H, Kazandi M, Itil IM, Askar N, Vidinli B, Pourbagher A (2003) Role of perineal sonography in the evaluation of patients with stress urinary incontinence. Aust N Z J Obstet Gynaecol 43(1):54–57

    Article  PubMed  Google Scholar 

  3. Heilbrun ME, Nygaard IE, Lockhart ME, Richter HE, Brown MB, Kenton KS, Rahn DD, Thomas JV, Weidner AC, Nager CW (2010) Correlation between levator ani muscle injuries on magnetic resonance imaging and fecal incontinence, pelvic organ prolapse, and urinary incontinence in primiparous women. Am J Obstet Gynecol 202(5):488. e481–488. e486

    Article  Google Scholar 

  4. Del Vescovo R, Piccolo CL, Della Vecchia N, Giurazza F, Cazzato RL, Grasso RF, Zobel BB (2014) MRI role in morphological and functional assessment of the levator ani muscle: use in patients affected by stress urinary incontinence (SUI) before and after pelvic floor rehabilitation. Eur J Radiol 83(3):479–486. doi:10.1016/j.ejrad.2013.11.021

    Article  PubMed  Google Scholar 

  5. Peng Y, Dai Z, Mansy HA, Sandler RH, Balk RA, Royston TJ (2014) Sound transmission in the chest under surface excitation: an experimental and computational study with diagnostic applications. Med Biol Eng Comput 52(8):695–706

    Article  PubMed Central  PubMed  Google Scholar 

  6. Wang S, Zhou Y, Tan J, Xu J, Yang J, Liu Y (2014) Computational modeling of magnetic nanoparticle targeting to stent surface under high gradient field. Comput Mech 53(3):403–412

    Article  PubMed Central  PubMed  Google Scholar 

  7. Peng Y, Khavari R, Nakib NA, Stewart JN, Boone TB, Zhang Y (2015) The single-incision sling to treat female stress urinary incontinence: a dynamic computational study of outcomes and risk factors. J Biomech Eng 137(9):091007

    Article  Google Scholar 

  8. Zhang Y, Kim S, Erdman AG, Roberts KP, Timm GW (2009) Feasibility of using a computer modeling approach to study SUI induced by landing a jump. Ann Biomed Eng 37(7):1425–1433

    Article  PubMed  Google Scholar 

  9. Luo J, Chen L, Fenner DE, Ashton-Miller JA, DeLancey JOL (2015) A multi-compartment 3-D finite element model of rectocele and its interaction with cystocele. J Biomech 48(9):1580–1586

    Article  PubMed  Google Scholar 

  10. Ren S, Xie B, Wang J, Rong Q (2015) Three-dimensional modeling of the pelvic floor support systems of subjects with and without pelvic organ prolapse. BioMed Res Int 2015

  11. Chen Z-W, Joli P, Feng Z-Q, Rahim M, Pirró N, Bellemare M-E (2015) Female patient-specific finite element modeling of pelvic organ prolapse (POP). J Biomech 48(2):238–245

    Article  PubMed  Google Scholar 

  12. Jing D, Ashton-Miller JA, DeLancey JO (2012) A subject-specific anisotropic visco-hyperelastic finite element model of female pelvic floor stress and strain during the second stage of labor. J Biomech 45(3):455–460

    Article  PubMed Central  PubMed  Google Scholar 

  13. Brandão S, Parente M, Mascarenhas T, da Silva ARG, Ramos I, Jorge RN (2015) Biomechanical study on the bladder neck and urethral positions: simulation of impairment of the pelvic ligaments. J Biomech 48(2):217–223. doi:10.1016/j.jbiomech.2014.11.045

    Article  PubMed  Google Scholar 

  14. Crystle CD, Charme LS, Copeland WE (1971) Q-tip test in stress urinary incontinence. Obstet Gynecol 38(2):313

    CAS  PubMed  Google Scholar 

  15. Ghoniem G, Stanford E, Kenton K, Achtari C, Goldberg R, Mascarenhas T, Parekh M, Tamussino K, Tosson S, Lose G (2008) Evaluation and outcome measures in the treatment of female urinary stress incontinence: International Urogynecological Association (IUGA) guidelines for research and clinical practice. Int Urogynecol J 19(1):5–33

    Article  CAS  Google Scholar 

  16. Wang Q, Zeng H, Best TM, Haas C, Heffner NT, Agarwal S, Zhao Y (2014) A mechatronic system for quantitative application and assessment of massage-like actions in small animals. Ann Biomed Eng 42(1):36–49

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  17. Dai Z, Peng Y, Mansy HA, Sandler RH, Royston TJ (2014) Comparison of poroviscoelastic models for sound and vibration in the lungs. J Vib Acoust 136(5):050905

    Article  Google Scholar 

  18. Zhou D, Peng Y, Bai J, Rosandich RG (2014) Contact effect evaluation using stress distribution in viscoelastic material under generalized loading. Int J Model Simul 34 (4)

  19. Cobb WS, Burns JM, Kercher KW, Matthews BD, Norton HJ, Heniford BT (2005) Normal intraabdominal pressure in healthy adults. J Surg Res 129(2):231–235

    Article  PubMed  Google Scholar 

  20. Brandt FT, Lorenzato FR, Nobrega LV, Albuquerque CD, Falcao R, Araujo Junior AA (2006) Intra-abdominal pressure measurement during ultrasound assessment of women with stress urinary incontinence: a novel model. Acta Cir Bras Soc Bras Desenvolvimento Pesqui Cir 21(4):237–241

    Google Scholar 

  21. Alafraa T, Schick E (2008) Relation between Intra-abdominal pressure variation and urethral hypermobility: the urethral mobility index. Poster Abstract at International Continence Society

  22. DeLancey JOL (2002) Fascial and muscular abnormalities in women with urethral hypermobility and anterior vaginal wall prolapse. Am J Obstet Gynecol 187(1):93–98. doi:10.1067/mob.2002.125733

    Article  PubMed  Google Scholar 

  23. Verelst M, Leivseth G (2007) Force and stiffness of the pelvic floor as function of muscle length: a comparison between women with and without stress urinary incontinence. Neurourol Urodyn 26(6):852–857

    Article  CAS  PubMed  Google Scholar 

  24. Chantereau P, Brieu M, Kammal M, Farthmann J, Gabriel B, Cosson M (2014) Mechanical properties of pelvic soft tissue of young women and impact of aging. Int Urogynecol J 25(11):1547–1553

    Article  CAS  PubMed  Google Scholar 

  25. Kociszewski J, Rautenberg O, Kolben S, Eberhard J, Hilgers R, Viereck V (2010) Tape functionality: position, change in shape, and outcome after TVT procedure—midterm results. Int Urogynecol J 21(7):795–800

    Article  PubMed Central  PubMed  Google Scholar 

  26. Brandão FSQdS, Parente MPL, Rocha PAGG, Saraiva MTdQeCdM, Ramos IMAP, Natal Jorge RM (2015) Modeling the contraction of the pelvic floor muscles. Comput Methods Biomech Biomed Eng 1–10. doi:10.1080/10255842.2015.1028031

  27. Peng Y, He J, Khavari R, Boone T, Zhang Y (2015) PD24-03 identification of innervation zones of the pelvic floor muscle from noninvasive high-density intra-vaginal/rectal surface EMG recordings. J Urol 4(193):e491

    Google Scholar 

  28. Liu Y, Ning Y, Li S, Zhou P, Rymer WZ, Zhang Y (2015) Three-dimensional innervation zone imaging from multi-channel surface EMG recordings. Int J Neural Syst 25(06):1550024

    Article  PubMed  Google Scholar 

  29. Yang L, Yong N, Jinbao H, Sheng L, Ping Z, Yingchun Z (2014) Internal muscle activity imaging from multi-channel surface EMG recordings: a validation study. In: Engineering in Medicine and Biology Society (EMBC), 2014 36th Annual International Conference of the IEEE, 26–30 Aug. 2014, pp 3559–3561. doi:10.1109/EMBC.2014.6944391

  30. Yong N, Xiangjun Z, Shanan Z, Yingchun Z (2015) Surface EMG decomposition based on K-means clustering and convolution kernel compensation. Biomed Health Inform IEEE J 19(2):471–477. doi:10.1109/JBHI.2014.2328497

    Article  Google Scholar 

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Acknowledgments

This work was supported in part by NIH 4R00DK082644, NIH K99DK082644 and the University of Houston. The authors thank Dr. John O. DeLancey from the University of Michigan for his valuable consultation and Mr. Thomas Potter for editing the manuscript.

Conflicts of interest

None.

Author information

Authors and Affiliations

  1. Department of Biomedical Engineering, Cullen College of Engineering, University of Houston, 2027 SERC Building, 3605 Cullen Blvd, Houston, TX, 77024, USA

    Yun Peng & Yingchun Zhang

  2. Department of Urology, Houston Methodist Hospital and Research Institute, Houston, TX, 77030, USA

    Rose Khavari & Timothy B. Boone

  3. Department of Urology, University of Minnesota, Minneapolis, MN, USA

    Nissrine A. Nakib

Authors
  1. Yun Peng
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  2. Rose Khavari
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  3. Nissrine A. Nakib
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  4. Timothy B. Boone
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  5. Yingchun Zhang
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Corresponding author

Correspondence to Yingchun Zhang.

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Peng, Y., Khavari, R., Nakib, N.A. et al. Assessment of urethral support using MRI-derived computational modeling of the female pelvis. Int Urogynecol J 27, 205–212 (2016). https://doi.org/10.1007/s00192-015-2804-8

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  • DOI: https://doi.org/10.1007/s00192-015-2804-8

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