“My Vagina Did What?”: Evaluating a 3D Mobile App of Enterocele Anatomy in Post‐Hysterectomy Women

Abstract

Pelvic organ prolapses are becoming more prevalent, with the number of diagnoses projected to increase by 46% in the United States by 2050. One type of prolapse is enterocele, a condition in which a peritoneal sac containing the small intestines herniates into the vaginal wall. Secondary to weakened pelvic floor muscles, enterocele is strongly associated with hysterectomy, with 60% of women diagnosed with enterocele having a past history of hysterectomy. Healthcare providers discover prolapse during a physical exam when the vaginal wall bulges outside the vaginal opening. Despite the increasing prevalence and complicated anatomy of enterocele, there are few resources to educate women on the anatomy of a prolapse. Knowledge gaps cause patients stress and shame surrounding their condition, limiting their ability to confide in others and seek medical advice. Thus, supplementing counseling with patient education resources on enterocele anatomy may increase patient understanding and improve communication between patient and provider. Effective counseling may decrease patient anxiety by addressing patient fears, relieving humiliation, and putting an end to self‐blame. The first aim of this project was to develop an interactive three‐dimensional (3D) mobile application (app) to assist healthcare providers in educating post‐hysterectomy women on the anatomy of enterocele. The second aim was to assess the educational value of the mobile app as a visual aid during counseling and its ability to increase patient understanding and decrease anxiety. The 3D model utilized in the app was segmented using 3D Slicer from a de‐identified CT urogram and pelvic MRI of a female diagnosed with enterocele post‐hysterectomy. Artifacts were smoothed in ZBrushCore 2018, and the model was animated in Autodesk Maya 2019. The model was imported into a game engine, Unreal Engine 4, and packaged into a mobile app, which was iteratively designed to highlight relevant structures of pelvic anatomy and allow the model to be enlarged and rotated. The mobile app was revised based on surveys from healthcare providers on the app’s usability and educational value. To test the efficacy of the app, patients were randomized into two groups: (1) a control group with standard counseling and (2) an experimental group with counseling supplemented by the mobile app. Patients completed pre‐ and post‐intervention surveys assessing anatomical understanding and anxiety regarding their diagnosis. Preliminary data suggest the mobile app has a high potential to assist healthcare providers with educating patients. Complete analysis of patient and clinician data will be presented. Women’s perspectives and issues are traditionally underrepresented in medicine. By developing a mobile app to increase awareness, we intend to normalize the conversation and overcome the social stigma of female pelvic organ prolapse.