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Review Article

Computational Modeling of the Female Pelvic Support Structures and Organs to Understand the Mechanism of Pelvic Organ Prolapse: A Review

[+] Author and Article Information
Arnab Chanda

Department of Aerospace Engineering and Mechanics,
University of Alabama,
Tuscaloosa, AL 35487
e-mail: achanda@crimson.ua.edu

Vinu Unnikrishnan

Assistant Professor
Mem. ASME
Department of Aerospace Engineering and Mechanics,
University of Alabama,
Tuscaloosa, AL 35487
e-mail: vunnikrishnan@ua.edu

Samit Roy

Mem. ASME
William D. Jordan Professor
Department of Aerospace Engineering and Mechanics,
University of Alabama,
Tuscaloosa, AL 35487
e-mail: sroy@eng.ua.edu

Holly E. Richter

J Marion Sims Professor of Obstetrics and Gynecology,
Urology and Geriatrics
Division of Urogynecology
and Pelvic Reconstructive Surgery,
Department of Obstetrics and Gynecology,
University of Alabama at Birmingham,
Birmingham, AL 35233
e-mail: hrichter@uabmc.edu

1Corresponding author.

Manuscript received February 1, 2015; final manuscript received June 30, 2015; published online July 27, 2015. Assoc. Editor: Ellen Kuhl.

Appl. Mech. Rev 67(4), 040801 (Jul 27, 2015) (14 pages) Paper No: AMR-15-1015; doi: 10.1115/1.4030967 History: Received February 01, 2015

Pelvic organ prolapse (POP) is an abnormality of the female pelvic anatomy due to events, such as multiple child births, menopause, and morbid obesity, which may lead to weakening of the pelvic floor striated muscles and smooth musculo-connective tissues. POP leads to dropping of the pelvic organs, namely, the bladder, uterus, and rectum into the vaginal canal and eventual protrusion, causing vaginal pain, pressure, difficulty emptying the bladder and rectum, and sexual dysfunction. Each year, close to 300,000 POP surgeries are performed in the U.S., out of which more than 60% of patients may face relapse conditions. A closer look into the problem reveals that POP surgery failures may be attributed mainly to the lack of understanding among medical practitioners on the mechanics of prolapse. In the literature, there have been attempts in the engineering community to understand prolapse using phenomenological computational modeling. This paper reviews the development and study of these numerical models, aimed at understanding the mechanics of POP. The various computational challenges related to geometry creation, material modeling, finite-element (FE) modeling, and boundary conditions (BCs) will be discussed and significant future research directions will also be highlighted in this review.

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Figures

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Fig. 1

Female pelvic system normal anatomy and various prolapse conditions

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Fig. 2

Typical pelvic floor muscle geometry of levator ani (the most important muscle in the female pelvic floor)

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Fig. 3

A typical pelvic system numerical model with bladder, vagina, urethra, and uterus

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Fig. 4

Typical 3D MRI image segmentation interface to create biological organ geometries

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