Three-dimensional modeling of the pelvic floor support systems of subjects with and without pelvic organ prolapse.

Shuang Ren,Jianliu Wang,Bing Xie,Qiguo Rong

doi:10.1155/2015/845985

Shuang Ren, Jianliu Wang + Show 2 more

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https://doi.org/10.1155/2015/845985

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Abstract

The purpose of this study was to develop three-dimensional finite element models of the whole pelvic support systems of subjects with and without pelvic organ prolapse (POP) that can be used to simulate anterior and posterior wall prolapses. Magnetic resonance imaging was performed in one healthy female volunteer (55 years old, para 2) and one patient (56 years old, para 1) with anterior vaginal wall prolapse. Contours of the pelvic structures were traced by a trained gynecologist. Smoothing of the models was conducted and attachments among structures were established. Finite element models of the pelvic support system with anatomic details were established for both the healthy subject and the POP patient. The models include the uterus, vagina with cavity, cardinal and uterosacral ligaments, levator ani muscle, rectum, bladder, perineal body, pelvis, obturator internus, and coccygeal muscle. Major improvements were provided in the modeling of the supporting ligaments and the vagina with high anatomic precision. These anatomically accurate models can be expected to allow study of the mechanism of POP in more realistic physiological conditions. The resulting knowledge may provide theoretical help for clinical prevention and treatment of POP.

Highlights

Pelvic floor prolapse (POP) is defined as downward descent of the pelvic floor organs, anterior compartment, uterus, vaginal cuff, and posterior compartment, resulting in protrusion of the vaginal wall, uterus, and/or vagina [1, 2]
In a healthy woman the pelvic support system can hold the organs in normal positions, a subtle injury of this support system may lead to progressive POP
We recruited one healthy female volunteer [55 years old, para 2; body mass index (BMI) 20.96 kg⋅m−2] and one patient (56 years old, para 1; BMI 27.89 kg⋅m−2) with anterior vaginal wall prolapse diagnosed based on clinical manifestations and the pelvic organ prolapse quantitation system (POPQ)

Summary

Introduction

Pelvic floor prolapse (POP) is defined as downward descent of the pelvic floor organs, anterior compartment (bladder and the urethra), uterus, vaginal cuff, and posterior compartment (rectum), resulting in protrusion of the vaginal wall, uterus, and/or vagina [1, 2]. Two-dimensional (2D) [6] and 3D [7] models of POP have been built to simulate prolapse of the anterior vaginal wall. These studies provided substantial clues for the diagnosis and treatment of POP, but there was oversimplification of apical ligament support in those studies. If the vagina model is created as a solid one, the anterior and posterior vaginal walls protrude together, so it is impossible to simulate the realistic situations of cystocele or rectocele. The vaginal cavity is of great significance when evaluating the mechanical behavior of POP

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