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Biomechanical paradigm and interpretation of female pelvic floor conditions before a treatment

Authors Lucente V, van Raalte H, Murphy M, Egorov V

Received 14 March 2017

Accepted for publication 10 June 2017

Published 3 August 2017 Volume 2017:9 Pages 521—550

DOI https://doi.org/10.2147/IJWH.S136989

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Leyla Bahar

Peer reviewer comments 2

Editor who approved publication: Professor Elie Al-Chaer

Vincent Lucente,1 Heather van Raalte,2 Miles Murphy,1 Vladimir Egorov3

1The Institute for Female Pelvic Medicine and Reconstructive Surgery, Allentown, PA, USA; 2Princeton Urogynecology, Princeton, NJ, USA; 3Artann Laboratories, Trenton, NJ, USA

Background: Further progress in restoring a woman’s health may be possible if a patient with a damaged pelvic floor could undergo medical imaging and biomechanical diagnostic tests. The results of such tests could contribute to the analysis of multiple treatment options and suggest the optimal one for that patient.
Aim: To develop a new approach for the biomechanical characterization of vaginal conditions, muscles, and connective tissues in the female pelvic floor.
Methods: Vaginal tactile imaging (VTI) allows biomechanical assessment of the soft tissue along the entire length of the anterior, posterior, and lateral vaginal walls at rest, with manually applied deflection pressures and with muscle contraction, muscle relaxation, and Valsalva maneuver. VTI allows a large body of measurements to evaluate individual variations in tissue elasticity, support defects, as well as pelvic muscle function. Presuming that 1) the female pelvic floor organs are suspended by ligaments against which muscles contract to open or close the outlets and 2) damaged ligaments weaken the support and may reduce the force of muscle contraction, we made an attempt to characterize multiple pelvic floor structures from VTI data.
Results: All of the 138 women enrolled in the study were successfully examined with the VTI. The study subjects have had normal pelvic support or pelvic organ prolapse (stages I–IV). The average age of this group of subjects was 60±15 years. We transposed a set of 31 VTI parameters into a quantitative characterization of pelvic muscles and ligamentous structures. Interpretation of the acquired VTI data for normal pelvic floor support and prolapse conditions is proposed based on biomechanical assessment of the functional anatomy.
Conclusion: Vaginal tactile imaging allows biomechanical characterization of female pelvic floor structures and tissues in vivo, which may help to optimize treatment of the diseased conditions such as prolapse, incontinence, atrophy, and some forms of pelvic pain.

Keywords: female pelvic floor, biomechanics, diagnostic, treatment, tactile imaging, tissue elasticity, pelvic muscles

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