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Assessment of urethral support using MRI-derived computational modeling of the female pelvis

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International Urogynecology Journal Aims and scope Submit manuscript

Abstract

Introduction and hypothesis

This study aimed to assess the role of individual anatomical structures and their combinations to urethral support function.

Methods

A realistic pelvic model was developed from an asymptomatic female patient’s magnetic resonance (MR) images for dynamic biomechanical analysis using the finite element method. Validation was performed by comparing simulation results with dynamic MR imaging observations. Weaknesses of anatomical support structures were simulated by reducing their material stiffness. Urethral mobility was quantified by examining urethral axis excursion from rest to the final state (intra-abdominal pressure = 100 cmH2O). Seven individual support structures and five of their combinations were studied.

Result

Among seven urethral support structures, we found that weakening the vaginal walls, puborectalis muscle, and pubococcygeus muscle generated the top three largest urethral excursion angles. A linear relationship was found between urethral axis excursions and intra-abdominal pressure. Weakening all three levator ani components together caused a larger weakening effect than the sum of each individually weakened component, indicating a nonlinearly additive pattern. The pelvic floor responded to different weakening conditions distinctly: weakening the vaginal wall developed urethral mobility through the collapsed vaginal canal, while weakening the levator ani showed a more uniform pelvic floor deformation.

Conclusions

The computational modeling and dynamic biomechanical analysis provides a powerful tool to better understand the dynamics of the female pelvis under pressure events. The vaginal walls, puborectalis, and pubococcygeus are the most important individual structures in providing urethral support. The levator ani muscle group provides urethral support in a well-coordinated way with a nonlinearly additive pattern.

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Acknowledgments

This work was supported in part by NIH 4R00DK082644, NIH K99DK082644 and the University of Houston. The authors thank Dr. John O. DeLancey from the University of Michigan for his valuable consultation and Mr. Thomas Potter for editing the manuscript.

Conflicts of interest

None.

Author information

Authors and Affiliations

  1. Department of Biomedical Engineering, Cullen College of Engineering, University of Houston, 2027 SERC Building, 3605 Cullen Blvd, Houston, TX, 77024, USA

    Yun Peng & Yingchun Zhang

  2. Department of Urology, Houston Methodist Hospital and Research Institute, Houston, TX, 77030, USA

    Rose Khavari & Timothy B. Boone

  3. Department of Urology, University of Minnesota, Minneapolis, MN, USA

    Nissrine A. Nakib

Authors
  1. Yun Peng
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  2. Rose Khavari
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  3. Nissrine A. Nakib
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  4. Timothy B. Boone
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  5. Yingchun Zhang
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Corresponding author

Correspondence to Yingchun Zhang.

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Peng, Y., Khavari, R., Nakib, N.A. et al. Assessment of urethral support using MRI-derived computational modeling of the female pelvis. Int Urogynecol J 27, 205–212 (2016). https://doi.org/10.1007/s00192-015-2804-8

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  • DOI: https://doi.org/10.1007/s00192-015-2804-8

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