Mechanical Properties of Female Reproductive Organs and Supporting Connective Tissues: A Review of the Current State of Knowledge

Baah-Dwomoh, Adwoa; McGuire, Jeffrey A.; Tan, Ting; Vita, R. De

doi:10.1115/1.4034442

Cited by 78 publications

(63 citation statements)

References 102 publications

(302 reference statements)

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“…2 Due to limited sample size and ethical concerns with examining human tissue, the selection of appropriate animal models for mechanical testing of pelvic tissues is crucial not only to explore the etiology of POP but also to develop new surgical techniques and better graft materials. Different animal models such as mice, rats, rabbits, sheep, swine, and nonhuman primates have been used to study POP.…”

Section: Discussionmentioning

confidence: 99%

“…47 measured the uniaxial elastic and stress relaxation response of USLs while, more recently, we characterized the elastic, stress relaxation and creep properties of the USL (and cardinal ligament) using the swine as animal model. 1,2,7,45,46 In addition to uniaxial tensile tests, 46 planar biaxial tensile tests, which better emulate the complex in vivo loading conditions of the USL, were performed. 2,7,45 …”

Section: Introductionmentioning

confidence: 99%

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Mechanical Analysis of the Uterosacral Ligament: Swine vs. Human

et al. 2018

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The uterosacral ligament (USL) is a major suspensory structure of the female pelvic floor, providing support to the cervix and/or upper vagina. it plays a pivotal role in surgical procedures for pelvic organ prolapse (PoP) aimed at restoring apical support. Despite its important mechanical function, little is known about the mechanical properties of the USL due to the constraints associated with in vivo testing of human USL and the lack of validated large animal models that enable such investigations. in this study, we provide the first comparison of the mechanical properties of swine and human USLs. Preconditioning and pre-creep data up to a 2 N load and creep data under a 2 N load over 1200 s were obtained on swine (n = 9) and human (n = 9) USL specimens by performing planar equi-biaxial tensile tests and using the digital image correlation method. No differences in the peak strain during preconditioning tests, secant modulus of the pre-creep response, and strain at the end of creep tests were detected in the USLs from the two species along both axial loading directions (the main in vivo loading direction and the direction that is perpendicular to it). These findings suggest that the swine holds promise as large animal model for studying the mechanical role of the USL in apical vaginal support and treatment of PoP.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Mechanical Analysis of the Uterosacral Ligament: Swine vs. Human

et al. 2018

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“…B) shows that the entrance of the vagina and urethra into the vulva is, nevertheless, a weak spot. The elastic moduli of vagina, uterus, cardinal, sacrouterine, and round ligaments are similar, whereas that of the cervix is smaller (Chantereau et al, ; Baah‐Dwomoh et al, ). In agreement, biomechanical studies identify the fixation of vagina and cervix as most prone to fail (Brandao et al, ; Peng et al, ).…”

Section: New Findingsmentioning

confidence: 99%

Interactive three‐dimensional teaching models of the female and male pelvic floor

Hikspoors

Dabhoiwala

et al. 2019

Clinical Anatomy

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Controversies regarding structure and function of the pelvic floor persist because of its poor accessibility and complex anatomical architecture. Most data are based on dissection. This "surgical" approach requires profound prior knowledge, because applying the scalpel precludes a "second look." The "sectional" approach does not entail these limitations, but requires segmentation of structures and threedimensional reconstruction. This approach has produced several "Visible Human Projects." We dealt with limited spatial resolution and difficult-to-segment structures by proceeding from clear-cut to more fuzzy boundaries and comparing segmentation between investigators. We observed that the bicipital levator ani muscle consisted of pubovisceral and puborectal portions; that the pubovisceral muscle formed, together with rectococcygeal and rectoperineal muscles, a rectal diaphragm; that the external anal sphincter consisted of its subcutaneous portion and the puborectal muscle only; that the striated urethral sphincter had three parts, of which the middle (urethral compressor) was best developed in females and the circular lower ("membranous") best in males; that the rectourethral muscle, an anterior extension of the rectal longitudinal smooth muscle, developed a fibrous node in its center (perineal body); that the perineal body was much better developed in females than males, so that the rectourethral subdivision into posterior rectoperineal and anterior deep perineal muscles was more obvious in females; that the superficial transverse perineal muscle attached to the fibrous septa of the ischioanal fat; and that the uterosacral ligaments and mesorectal fascia colocalized. To facilitate comprehension of the modified topography we provide interactive 3D-PDFs that are freely available for teaching purposes.

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“…Of the connective tissues that provide support to the vagina, the uterosacral ligament complex (USL), which supports the upper vagina (apex) and cervix, has been most studied [10, 15, 16]. Restoration of apical support to the vagina is, indeed, key in achieving successful anatomical outcomes in the long term, and approximately 50% of what is observed as anterior prolapse is due to loss of support at the apex [17–19].…”

Section: Experimental Mechanicsmentioning

confidence: 99%

“…In the last decade, progress has been made regarding the mechanical characterization of the vagina, bladder, urethra, rectum, cervix, uterus, connective tissues, and musculature of the pelvic floor [10]. However, some of the greatest remaining challenges stem from the ethical issues surrounding procurement of human tissues, in significant quantities, that span the average 35-year time gap between maternal birth injury and the onset of symptoms for POP [11, 12].…”

Section: Introductionmentioning

confidence: 99%

Female pelvic floor biomechanics

Easley

Abramowitch

Moalli

2017

Current Opinion in Urology

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Purpose of review The pelvic floor is a complex assembly of connective tissues and striated muscle that simultaneously counteract gravitational forces, inertial forces, and intraabdominal pressures while maintaining the position of the pelvic organs. In 30% of women, injury or failure of the pelvic floor results in pelvic organ prolapse (POP). Surgical treatments have high recurrence rates, due, in part, to a limited understanding of physiologic loading conditions. It is critical to apply biomechanics to help elucidate how altered loading conditions of the pelvis contribute to the development of pelvic organ prolapse and to define surgeries to restore normal support. Recent findings Evidence suggests the ewe is a potential animal model for studying vaginal properties and that uterosacral and cardinal ligaments experience significant creep, which may be affecting surgical outcomes. A new method of measuring ligament displacements in vivo was developed, and finite element models that simulate urethral support, pelvic floor dynamics, and the impact of episiotomies on the pelvic floor were studied. Summary This review highlights some contributions over the past year, including mechanical testing and the creation of models, which are used to understand pelvic floor changes with loading, and the impact of surgical procedures, to illustrate how biomechanics is being utilized.

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Mechanical Properties of Female Reproductive Organs and Supporting Connective Tissues: A Review of the Current State of Knowledge

Cited by 78 publications

References 102 publications

Mechanical Analysis of the Uterosacral Ligament: Swine vs. Human

Mechanical Analysis of the Uterosacral Ligament: Swine vs. Human

Interactive three‐dimensional teaching models of the female and male pelvic floor

Female pelvic floor biomechanics

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