Biomechanical paradigm and interpretation of female pelvic floor conditions before a treatment

Abstract

BackgroundFurther progress in restoring a woman’s health may be possible if a patient with a damaged pelvic floor could undergo medical imaging and biomechanical diagnostic tests. The results of such tests could contribute to the analysis of multiple treatment options and suggest the optimal one for that patient.AimTo develop a new approach for the biomechanical characterization of vaginal conditions, muscles, and connective tissues in the female pelvic floor.MethodsVaginal tactile imaging (VTI) allows biomechanical assessment of the soft tissue along the entire length of the anterior, posterior, and lateral vaginal walls at rest, with manually applied deflection pressures and with muscle contraction, muscle relaxation, and Valsalva maneuver. VTI allows a large body of measurements to evaluate individual variations in tissue elasticity, support defects, as well as pelvic muscle function. Presuming that 1) the female pelvic floor organs are suspended by ligaments against which muscles contract to open or close the outlets and 2) damaged ligaments weaken the support and may reduce the force of muscle contraction, we made an attempt to characterize multiple pelvic floor structures from VTI data.ResultsAll of the 138 women enrolled in the study were successfully examined with the VTI. The study subjects have had normal pelvic support or pelvic organ prolapse (stages I–IV). The average age of this group of subjects was 60±15 years. We transposed a set of 31 VTI parameters into a quantitative characterization of pelvic muscles and ligamentous structures. Interpretation of the acquired VTI data for normal pelvic floor support and prolapse conditions is proposed based on biomechanical assessment of the functional anatomy.ConclusionVaginal tactile imaging allows biomechanical characterization of female pelvic floor structures and tissues in vivo, which may help to optimize treatment of the diseased conditions such as prolapse, incontinence, atrophy, and some forms of pelvic pain.

Biomechanical Mapping of the Female Pelvic Floor: Prolapse versus Normal Conditions

“…Table 2 lists 52 biomechanical parameters being calculated for every 96 participating subject based on VTI data recorded in tests 1 – 8. Anatomical assignment of the targeting/contributing pelvic structures into the specified parameters is based on already published data [8] [13] [14] [15] [16] [17].…”

Tactile and Ultrasound Image Fusion for Functional Assessment of the Female Pelvic Floor

“…Comparative Test 2 (probe elevation) results for patients with normal pelvic support (no POP) and with stage II POP are presented in Figure 3. Tissue deformation (up to 45 mm) in posterior compartment (see Figure 3(C)) allows acquisition of pressure feedback patterns versus the probe angle to quantify the pelvic floor support at Levels I-III, as defined by DeLancey [19], because the deeper support structures contribute to the pressure patterns on the vaginal wall at such deformations [10]. The tactile ultrasound image fusion (see Figure 4(A) and Figure 4(B)) provides anatomical identification of the levels of support.…”

“…A representative study reported a POP surgical failure rate of 61.5% for uterosacral ligament suspension and 70.3% for sacrospinous ligament fixation groups [9]. Substantial improvement is possible if patients with the diseased pelvic floor conditions undergo imaging and biomechanical diagnostic tests, the results of which could be fed into a patient-specific optimal treatment [10] [11] [12].…”

Preoperative biomechanical mapping of the female pelvic floor

“…Therefore, biomechanical mapping of a response to applied pressure or load within the pelvic floor opens new possibilities in biomechanical assessment and monitoring of pelvic floor conditions. An innovative approach, vaginal tactile imaging, allows biomechanical mapping of the female pelvic floor including assessment of tissue elasticity, pelvic support and pelvic muscle functions in high definition [1–3]. This case report on a patient with POP demonstrates preoperative tactile imaging, functional tactile imaging and brings an example of the biomechanical parameters (vaginal tissue elasticity, support structures and functions) of the pelvic floor.…”