Role of fibulin-5 insufficiency and prolapse progression on murine vaginal biomechanical function.

The vagina plays a critical role in supporting the pelvic organs and loss of support leads to pelvic organ prolapse. It is unknown what microstructural changes influence prolapse progression nor how decreased elastic fibers contributes to vaginal remodeling and smooth muscle contractility. The objective for this study was to evaluate the effect of fibulin-5 haploinsufficiency, and deficiency with progressive prolapse on the biaxial contractile and biomechanical function of the murine vagina.

Investigation of Murine Vaginal Creep Response to Altered Mechanical Loads.

The vagina is a viscoelastic fibromuscular organ that provides support to the pelvic organs. The viscoelastic properties of the vagina are understudied but may be critical for pelvic stability. Most studies evaluate vaginal viscoelasticity under a single uniaxial load; however, the vagina is subjected to dynamic multiaxial loading in the body.

Pelvic Organ Prolapse: A Review of In Vitro Testing of Pelvic Support Mechanisms.

Pelvic organ prolapse (POP) affects a significant portion of the female population, impacting quality of life and often requiring intervention. The exact cause of prolapse is unknown. We review some of the current research that focuses on defining the elements involved in POP, with a focus on in vitro testing.

Botulinum Toxin A: A Review of Potential Uses in Treatment of Female Urogenital and Pelvic Floor Disorders.

Botulinum toxin is an injectable neuromodulator that inhibits transmission between peripheral nerve endings and muscle fibers, resulting in muscle paralysis. Botulinum toxin type A is the most common form of botulinum toxin used in clinical practice. In this review, we examine the mechanism of action, formulations, common clinical use in the genital-urinary tract, and potential clinical use in pelvic floor disorders of botulinum toxin type A.

Comparison of Biaxial Biomechanical Properties of Post-menopausal Human Prolapsed and Non-prolapsed Uterosacral Ligament.

Uterosacral ligaments (USLs) provide structural support to the female pelvic floor, and a loss of USL structural integrity or biomechanical function may induce pelvic organ prolapse (POP). Alterations in extracellular matrix composition and organization dictate USL mechanical function. Changes in USL microstructure and corresponding mechanical properties, however, are not fully understood, nor is it understood how microstructure and mechanics change with onset and progression of POP.

Biaxial biomechanical properties of the nonpregnant murine cervix and uterus.

From a biomechanical perspective, female reproductive health is an understudied area of research. There is an incomplete understanding of the complex function and interaction between the cervix and uterus. This, in part, is due to the limited research into multiaxial biomechanical functions and geometry of these organs.

Smooth muscle regional contribution to vaginal wall function.

Pelvic organ prolapse is characterized as the descent of the pelvic organs into the vaginal canal. In the USA, there is a 12% lifetime risk for requiring surgical intervention. Although vaginal childbirth is a well-established risk factor for prolapse, the underlying mechanisms are not fully understood.

Evaluating residual strain throughout the murine female reproductive system.

Mounting evidence suggests that cells within soft tissues seek to maintain a preferred biomechanical state. Residual stress is defined as the stress that remains in a tissue when all external loads are removed and contributes to tissue mechanohomeostasis by decreasing the transmural gradient of wall stress. Current computational models of pelvic floor mechanics, however, often do not consider residual stress.

Effects of Elastase Digestion on the Murine Vaginal Wall Biaxial Mechanical Response.

Although the underlying mechanisms of pelvic organ prolapse (POP) remain unknown, disruption of elastic fiber metabolism within the vaginal wall extracellular matrix (ECM) has been highly implicated. It has been hypothesized that elastic fiber fragmentation correlates to decreased structural integrity and increased risk of prolapse; however, the mechanisms by which elastic fiber damage may contribute to prolapse are poorly understood. Furthermore, the role of elastic fibers in normal vaginal wall mechanics has not been fully ascertained.

Cervical pathways for racial disparities in preterm births: the Preterm Prediction Study.

Racial disparities in preterm birth have been long recognized, but the social and biological mechanisms for these differences are unclear. Our analysis had three goals: (1) to determine the relation between race and other social risk factors and cervical structure; (2) to determine whether social factors mediate the relation between race and cervical structure; and (3) to determine whether racial disparities in preterm birth (PTB) are mediated through changes in cervical structure observed earlier in pregnancy. Data from the Maternal Fetal Medicine Unit network Preterm Prediction Study were used to examine the relation between race and other social factors and cervical properties throughout pregnancy in 2920 black and white women.

Biaxial Mechanical Assessment of the Murine Vaginal Wall Using Extension-Inflation Testing.

Progress toward understanding the underlying mechanisms of pelvic organ prolapse (POP) is limited, in part, due to a lack of information on the biomechanical properties and microstructural composition of the vaginal wall. Compromised vaginal wall integrity is thought to contribute to pelvic floor disorders; however, normal structure-function relationships within the vaginal wall are not fully understood. In addition to the information produced from uniaxial testing, biaxial extension-inflation tests performed over a range of physiological values could provide additional insights into vaginal wall mechanical behavior (i.

Does bariatric surgery affect urinary incontinence?

Objective: To determine International Classification of Disease, 9th Revision, (ICD-9) coding patterns as a proxy for incidence and prevalence of urinary incontinence (UI) in a population of patients before and after a bariatric surgical procedure for the treatment of obesity.

Methods: We evaluated claims from a national private insurer over a 5-year period (2002-2006) to identify female patients who underwent bariatric surgery and had 3 years of follow-up claims data. The cohort of patients who underwent bariatric surgery (treatment) was matched to a cohort of obese female patients who did not undergo bariatric surgery (control), who were followed from the start of their enrollment.

Joint hypermobility, obstetrical outcomes, and pelvic floor disorders.

Introduction And Hypothesis: Benign joint hypermobility syndrome may be a risk factor for pelvic floor disorders. It is unknown whether hypermobility impacts the progress of childbirth, a known risk factor for pelvic floor disorders. Our objective was to investigate the association between joint hypermobility syndrome, obstetrical outcomes, and pelvic floor disorders.

Recurrent pelvic organ prolapse in a patient with history of bladder exstrophy.

Background: Increased risk of pelvic organ prolapse in women with a history of bladder exstrophy poses difficult management owing to the absence of anterior support and pelvic angle. We present a case of recurrent prolapse in the setting of bladder exstrophy and discuss factors that may warrant consideration during the evaluation of such patients.

Case: A 26-year-old nulliparous woman with a history of bladder exstrophy and pelvic organ prolapse initially repaired with a porcine graft sacral hysteropexy presented with suspected recurrent apical prolapse.

Pelvic floor disorders 5-10 years after vaginal or cesarean childbirth.

Objective: To estimate differences in pelvic floor disorders by mode of delivery.

Methods: We recruited 1,011 women for a longitudinal cohort study 5-10 years after first delivery. Using hospital records, we classified each birth as: cesarean without labor, cesarean during active labor, cesarean after complete cervical dilation, spontaneous vaginal birth, or operative vaginal birth.

Teaching subcuticular suturing to medical students: video versus expert instructor feedback.

Objective: Given limitations in surgical educational resources, more efficient teaching methods are needed. We sought to evaluate 3 strategies for improving skills in subcuticular suturing-practice with an instructional video, practice with expert instructor supervision, and independent practice.

Design: Fifty-eight medical students volunteered for this research.

Sexual complaints, pelvic floor symptoms, and sexual distress in women over forty.

Introduction: The American Psychiatric Association recommends considering sexually related personal distress when assessing female sexual dysfunction. Currently, there is little data regarding the impact of sexual complaints on sexual distress.

Aim: To investigate the association between sexual complaints and perceived sexual distress in a population of ambulatory adult women.

Anatomic outcomes of abdominal sacrocolpopexy with or without paravaginal repair.

Introduction And Hypothesis: We sought to compare rates of recurrent cystocele following sacrocolpopexy with and without paravaginal repair (PVR).

Methods: This retrospective cohort study compared outcomes for patients undergoing sacrocolpopexy with (group A) and without (group B) concomitant PVR. Defining anterior failure as point Ba > or = -1 cm, we compared anatomic outcomes and reoperation rates for recurrence of cystocele.