Biomechanical study on the bladder neck and urethral positions: Simulation of impairment of the pelvic ligaments
Biomechanical study on the bladder neck and urethral positions: Simulation of impairment of the pelvic ligaments
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DOI：
10.1016/j.jbiomech.2014.11.045
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发表时间：
2015-01-21
影响因子：
2.4
通讯作者：
Jorge, Renato Natal
中科院分区：
文献类型：
--
作者：
Brandao, Sofia;Parente, Marco;Jorge, Renato Natal
膀胱颈和尿道的过度活动是压力性尿失禁的常见特征。我们的目的是评估，通过计算建模，膀胱颈的位置考虑到渐进性损害的骨盆ligaments. MRI图像的一个年轻的健康女性被用来建立一个计算模型的盆腔。定义了适当的材料特性和本构模型。对于健康的韧带，valsalva动作导致α角增加，而对于正常的韧带，valsalva动作导致α角增加，（膀胱颈-耻骨联合与耻骨联合主干之间）由静止时的91.8 °降至105.7 °，膀胱颈脱位5.7mm，这与同一妇女的动态成像相似（α角从80度到103.3度，膀胱颈移动5 mm）。95%损伤时，尿道运动范围扩大至124.28 °和12 mm，耻骨尿道韧带损伤对尿道运动的影响大于阴道支撑（115 ° vs.108 °和9.1vs.73mm）。结果与文献中发表的大陆妇女和压力性尿失禁妇女的结果相似。耻骨尿道韧带的生物力学分析补充了尿失禁时盆腔的生物力学研究。它可能是有用的年轻女性压力性尿失禁，没有影像学证据的尿道和肌肉病变或器官下降，在瓦氏手术，对谁筋膜损伤是没有预期的。(C)2014爱思唯尔有限公司版权所有。
Excessive mobility of the bladder neck and urethra are common features in stress urinary incontinence. We aimed at assessing, through computational modelling, the bladder neck position taking into account progressive impairment of the pelvic ligaments.Magnetic resonance images of a young healthy female were used to build a computational model of the pelvic cavity. Appropriate material properties and constitutive models were defined. The impairment of the ligaments was simulated by mimicking a reduction in their stiffness.For healthy ligaments, valsalva maneuver led to an increase in the alpha angle (between the bladder neck-symphysis pubis and the main of the symphysis) from 91.8 degrees(at rest) to 105.7 degrees, and 5.7 mm of bladder neck dislocation, which was similar to dynamic imaging of the same woman (alpha angle from 80 degrees to 103.3 degrees, and 5 mm of bladder neck movement). For 95% impairment, they enlarged to 124.28 degrees and 12 mm. Impairment to the pubourethral ligaments had higher effect than that of vaginal support (115 degrees vs. 108 degrees, and 9.1 vs. 73 mm).Numerical simulation could predict urethral motion during valsalva maneuver, for both healthy and impaired ligaments. Results were similar to those of continent women and women with stress urinary incontinence published in the literature. Biomechanical analysis of the pubourethral ligaments complements the biomechanical study of the pelvic cavity in urinary incontinence. It may be useful in young women presenting stress urinary incontinence without imaging evidence of urethral and muscle lesions or organ descend during valsalva, and for whom fascial damage are not expected. (C) 2014 Elsevier Ltd. All rights reserved.