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research-article

Vaginal Changes Due to Varying Degrees of Rectocele Prolapse: A Computational Study

[+] Author and Article Information
Arnab Chanda

Graduate Student Department of Aerospace Engineering and Mechanics, University of Alabama, Tuscaloosa 35487
achanda@crimson.ua.edu

Isuzu Meyer

Department of Obstetrics and Gynecology, University of Alabama at Birmingham
imeyer@uabmc.edu

Holly E. Richter

J Marion Sims Professor of Obstetrics and Gynecology, Urology and Geriatrics Director Division of Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics and Gynecology, University of Alabama at Birmingham
hrichter@uabmc.edu

Mark. E Lockhart

Professor of Diagnostic Radiology, Department of Radiology, University of Alabama at Birmingham
mlockhart@uabmc.edu

Fabia R. D. Moraes

Department of Mechanical Engineering, Sao Paulo State University, Brazil
fabia_moraes@hotmail.com

Vinu U. Unnikrishnan

Assistant Professor Department of Aerospace Engineering and Mechanics, University of Alabama, Tuscaloosa 35487
vunnikrishnan@ua.edu

1Corresponding author.

ASME doi:10.1115/1.4037222 History: Received December 08, 2016; Revised June 15, 2017

Abstract

Pelvic organ prolapse (POP), downward descent of the pelvic organs resulting in a protrusion of the vagina, is a highly prevalent condition, responsible for 300,000 surgeries in the United States annually. Rectocele, a posterior vaginal wall prolapse of the rectum is the second most common type of POP after cystocele. A rectocele usually manifests itself along with other types of prolapse with multi-compartment pelvic floor defects. To date, the specific mechanics of rectocele formation are poorly understood, which does not allow its early stage detection and progression prediction over time. Recently, with the advancement of imaging and computational modeling techniques, a plethora of finite element (FE) models have been developed to study vaginal prolapse from different perspectives and allow a better understanding of dynamic interactions of pelvic organs and their supporting structures. So far, most studies have focused on anterior vaginal prolapse (or cystocele) and limited data exist on the role of pelvic muscles and ligaments on the development and progression of rectocele. In the current work, a full scale 3-dimensional (3D) computational model of the female pelvic anatomy, comprising the vaginal canal, uterus, rectum and the fibromuscular connective tissue between the rectum and the posterior vaginal wall, has been developed to study the effect of varying degrees (or sizes) of rectocele prolapse on the vaginal canal for the first time. Vaginal wall displacements and stresses generated due to the varying rectocele size were estimated objectively. Additionally, clinical relevance and implications of the results were discussed.

Copyright (c) 2017 by ASME
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