Interaction of pre-operative structural failure sites and operative repair strategies in prolapse: A biomechanical modeling approach

描述（由申请人提供）：盆腔器官脱垂严重到足以导致每年超过200，000名妇女接受手术修复，预计随着人口老龄化，患病率将增加。然而，手术干预失败率很高，前室脱垂是最常见的失败部位。缺乏识别导致脱垂的结构缺陷的部位和程度的特定组合的能力，以及预测给定手术策略在给定特定女性中的成功的能力，限制了我们理解手术失败的能力，并限制了有效的手术计划和治疗创新。鉴于这种知识差距，我们建议开发一种计算机建模方法，使外科医生能够评估不同类型和组合的骨盆支撑缺陷的个体的各种骨盆底手术策略的结果。我们寻求资金，以建立概念框架，并证明通过专注于顶端悬吊手术，如腹部骶骨阴道固定术前室为主脱垂的可行性。目的1，基于多结构失效假设创建受试者特定的生物力学预测模型，并根据术后MRI测量结果验证这些模型预测。目的2，进行敏感性分析，系统研究各种术前结构损伤和结构损伤组合如何影响心尖悬吊手术结局，并确定损伤组合和阈值，超过这些阈值，单独心尖悬吊手术不足以恢复前室支持。这些模型可以扩展到预测其他手术方法的结果，如阴道旁修复和中线前阴道缝合术，以及它们与随后R01中的根尖悬吊术的相互作用。这些完整且经过验证的模型可用作实验平台，允许外科医生和生物医学设计工程师以快速，安全和通常廉价的方式回答有关手术计划和治疗创新的问题，并最大限度地减少对接受盆腔脱垂手术的女性的潜在伤害。

DESCRIPTION (provided by applicant): Pelvic organ prolapse severe enough to result in surgical repair in over 200,000 women each year and is anticipated to increase in prevalence with our aging population. However, the rate of surgical intervention failure is significant and anterior compartment prolapse is the most common site of failure. Lack of the ability to identify the specific combination of site and magnitude of structure defects leading to her prolapse and predict the success of a given operative strategy in a given specific woman limit our ability to understand operative failure and hinge the effective surgical planning and treatment innovation. Given this knowledge gap, we propose to develop a computer modeling approach that will allow surgeons to evaluate the outcome of various pelvic floor surgical strategies in individuals with different types and combinations of pelvic support defects. We seek funding to establish the conceptual framework and demonstrate the feasibility by focusing on apical suspension surgeries such as abdominal sacrocolpopexy surgery for anterior compartment predominant prolapse. Aim 1, Create subject-specific biomechanical prediction models based on the multiple structural failure hypothesis and validate those model predictions against post-operative MRI measurements. Aim 2, Conduct sensitivity analyses, systematically study how various pre-operative structural impairments and combinations of structural impairments affect apical suspension surgery outcome, and identify impairment combinations and thresholds beyond which apical suspension surgery alone is not adequate to restore anterior compartment support. These models can be extended to predict the outcome of other surgical approaches such as the paravaginal repair and midline anterior colporrhaphy as well as their interaction with apical suspension surgery in the subsequent R01. These complete and validated models could be used as experimental platform allowing surgeons and biomedical design engineers answer the questions regarding to surgical planning and treatment innovations in a fast, safe and generally inexpensive manner and minimize potential harm for women who undergo pelvic prolapse surgery.