Female pelvic floor biomechanics

Easley, Deanna C.; Abramowitch, Steven D.; Moalli, Pamela

doi:10.1097/mou.0000000000000380

Cited by 25 publications

(15 citation statements)

References 34 publications

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“…We believe the main cause of the apical point (D) elevation is the shortening and repositioning of the uterosacral and cardinal ligaments (US/CL), as these ligaments are known to contain both elastin and smooth muscle fibers [23]. Although this step is crucial in the original description of the MP [14], we suspect that it is often neglected during surgery.…”

Section: Discussionmentioning

confidence: 99%

The Manchester procedure: anatomical, subjective and sexual outcomes

et al. 2018

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Section: Discussionmentioning

confidence: 99%

The Manchester procedure: anatomical, subjective and sexual outcomes

et al. 2018

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“…Biomechanics is an interdisciplinary area of research that involves the study of how the forces acting on structural elements of the human body create the motion that leads to normal development and functioning or to tissue damage under overloaded conditions 118 . The biomechanics of the female pelvic floor is a developing area of interest and limited knowledge of it is one of the factors that precludes definition of treatment targets and, therefore, the design requirements for prosthetic materials 119 . Current knowledge of the mechanical characteristics of the female pelvic floor is based on mechanical testing of whole pelvic floor samples from small animals (such as vaginal supportive tissue complex described in rats for experimental purposes ) 120,121 or biopsies from humans 122 .…”

Section: [H3] Biocompatibilitymentioning

confidence: 99%

Landmarks in vaginal mesh development: polypropylene mesh for treatment of SUI and POP

et al. 2019

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Vaginal meshes used in the treatment of stress urinary incontinence (SUI) and pelvic organ prolapse (POP) have produced highly variable outcomes causing life-changing complications in some patients while providing others with effective, minimally invasive treatments. The issue surrounding the risk:benefit ratio when using the vaginal meshes is complex in which a combination of several factors, including the inherent incompatibility of the mesh material with some applications in pelvic reconstructive surgeries and the lack of appropriate regulatory approval processes at the time of premarket clearance of these products , have contributed to occurrence of complications caused by vaginal mesh. Surgical mesh used in hernia repair has evolved over many years from metal implants to knitted polymer meshes that were adopted for use in the pelvic floor for treatment of POP and SUI. The evolution of the material and textile properties of the surgical mesh was guided by clinical feedback from hernia repair procedures, which were also being modified to obtain the best outcomes with use of the mesh. Current evidence shows how surgical mesh fails biomechanically when used in pelvic floor and materials with improved performance can be developed using modern material processing and tissue engineering techniques. [H1] IntroductionVaginal meshes that are currently used in the surgical treatment of stress urinary incontinence (SUI) and pelvic organ prolapse (POP) can result in life-changing complications in some women who have vaginal mesh implants 1 . These adverse outcomes are now considered a major public health problem; New Zealand becoming the first country in the world to ban the use of transvaginal POP mesh products while still allowing transvaginal SUI meshes (except minislings) in December 2017 2 . In the UK, two public enquiries performed by the Scottish (in 2015) 3 and English (in 2017) 4 governments, in part, as a result of pressure from patient groups led to suspension of vaginal mesh products, both for SUI and POP, from July 2018 onwards 5 . The newest guidance by the National Institute of Health and Care Excellence (NICE) in the UK recommends that retropubic sling materials can be offered to women with SUI if nonsurgical management has failed 6 . In response, the British Society of Urogynaecologists expressed strong disagreement with the decision to suspend the use of vaginal mesh for SUI, but not POP, stating that this decision would deprive many women of an effective and safe treatment option as demonstrated by level I evidence 7 8 . Mesh manufacturers are currently facing lawsuits in the USA and Europe 9 . The issue with mesh repairs for SUI and POP is complex, as the vaginal mesh is implanted in the female pelvic floor in several different ways with very different outcomes in efficacy and complication outcomes. When used as a tape to treat SUI, many patients are effectively cured with the benefits outweighing the risks 10,11 , whereas when used for transvaginal POP repair, complications are more frequent 12 with...

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“…Increasingly, alternative methods of quantifying the biomechanics of the pelvic floor, including computational methods and animal models, have been used 54 . Recent advances have helped us to better quantify the biomechanical properties of the female pelvic floor and in turn should lead to products with better in vivo predictability in the future.…”

Section: Animal Modelsmentioning

confidence: 99%

Recent advances in pelvic floor repair

2019

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Stress urinary incontinence (SUI) and pelvic organ prolapse (POP) are conditions which result in significant physical, mental and social consequences for women worldwide. The high rates of recurrence reported with primary repair for POP led to the use of synthetic mesh to augment repairs in both primary and secondary cases following failed previous POP repair. The widely reported, unacceptably high rates of complications associated with the use of synthetic, transvaginal mesh in pelvic floor repair have severely limited the treatment options that surgeons can offer. This article summarises the recent advances in pelvic floor repair, such as improved quantification and modelling of the biomechanics of the pelvic floor and the developing technology within the field of tissue engineering for treatment of SUI/POP, including biomaterials and cell-based therapies. Finally, we will discuss the issues surrounding the commercial introduction of synthetic mesh for use within the pelvic floor and what lessons can be learned for the future as well as the current guidance surrounding treatment for SUI/POP.

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Female pelvic floor biomechanics

Cited by 25 publications

References 34 publications

The Manchester procedure: anatomical, subjective and sexual outcomes

The Manchester procedure: anatomical, subjective and sexual outcomes

Landmarks in vaginal mesh development: polypropylene mesh for treatment of SUI and POP

Recent advances in pelvic floor repair

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