International Urogynecology Journal

, Volume 25, Issue 4, pp 499–506 | Cite as

Calculation of membrane tension in selected sections of the pelvic floor

  • Yves Ozog
  • Jan Deprest
  • Kim Haest
  • Filip Claus
  • Dirk De Ridder
  • Edoardo Mazza
Original Article

Abstract

Introduction and hypothesis

A mathematical model to estimate membrane tensions (Mt) at the urogenital hiatus and midpelvis in patients with and without prolapse is proposed. For that purpose the complex structures of the pelvic floor were simplified and, based on assumptions concerning geometry and loading conditions, Laplace’s law was used to calculate Mt. The pelvic cavity is represented by an ellipsoid in which the midpelvic and hiatal sections are described by an ellipse. The downwards forces within the pelvis (Fin) are in equilibrium with the support forces within its walls (Fw). Fin is the abdominal pressure (PABD) multiplied by the area A of the ellipse. The force inside the tissues (Fw) is distributed along the circumference of the ellipse C. The Mt can be approximated as Mt = (PABD.A)/C (N/m). Mt-α accounts for the angle α which describes tissue orientation with respect to the anatomical section and is calculated as Mt-α = Mt/sin(α).

Methods

We conducted a retrospective study on archived magnetic resonance imaging scans (n = 20) and ultrasound images in patients with (n = 50) or without prolapse (n = 50) and measured actual geometrical variables. PABD was measured in patients with and without prolapse (n = 20).

Results

Mt at the urogenital hiatus at rest is 0.35 N/cm. They significantly increase with the Valsalva manoeuvre, by a factor of 2.3 (without prolapse) to 3.6 (with prolapse).

Conclusions

Calculated Mt are much lower than what is reported for the abdominal cavity. Prolapse patients have significantly larger Mt, which during the Valsalva manoeuvre increase more than in healthy subjects.

Keywords

Laplace’s law Mathematical model Membrane tension Pelvic organ prolapse 

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Copyright information

© The International Urogynecological Association 2013

Authors and Affiliations

  • Yves Ozog
    • 1
  • Jan Deprest
    • 1
    • 2
    • 3
    • 6
  • Kim Haest
    • 2
    • 3
  • Filip Claus
    • 4
  • Dirk De Ridder
    • 2
    • 3
  • Edoardo Mazza
    • 5
  1. 1.Centre for Surgical Technologies, Faculty of MedicineKatholieke Universiteit LeuvenLeuvenBelgium
  2. 2.Pelvic Floor UnitUniversity Hospitals LeuvenLeuvenBelgium
  3. 3.Department of Development and Regeneration, Faculty of MedicineLeuvenBelgium
  4. 4.Department of Medical ImagingUniversity Hospitals LeuvenLeuvenBelgium
  5. 5.Department of Mechanical and Process Engineering, Swiss Federal Institute of TechnologyZurich and EMPA Materials Science and TechnologyDübendorfSwitzerland
  6. 6.Clinical Department Woman and Child, Division WomanUniversity Hospitals LeuvenLeuvenBelgium

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