Objectives: This study focuses on enhancing Pelvic Organ Prolapse (POP) management through a computational model. It models the prolapsed vaginal canal's biomechanics to deepen our understanding of its dynamicity and to support improvements of future pessary designs. The goal is to leverage this computational model to provide more effective, personalized treatment options, thereby improving the quality of life for women affected by POP.
Methods: Our approach involved the creation of a detailed vaginal model, using high-resolution MRI scans from a healthy 25-year-old female. Through the application of the finite element method (FEM), we were able to simulate the biomechanical changes and characteristics of POP. The model effectively incorporated the Pelvic Organ Prolapse Quantification (POP-Q) system to assess deformations within the vaginal canal. We further harnessed reaction forces derived from this displacement-driven model in constructing a secondary model to evaluate pessary designs, particularly focusing on varied loading scenarios induced by POP. We validated our model by correlating its contact stress outputs with measurements acquired from Vaginal Tactile Imaging (VTI), a vaginal pressure mapping tool, during Valsalva maneuvers. This comparison reinforced the accuracy of our model in simulating POP biomechanics. The foundation of our research, comprising of MRI scans, POP-Q measurements, and VTI profiles, is rooted in publicly accessible data.
Results: The reaction forces obtained from the POP-Q displacement driven finite element model of the vaginal canal showed relatively identical deformation in comparison with the MRI scans. The key reference points, namely A_p, B_p, A_a, B_a, C_a, and D_p demonstrated shifts of about -1.5, -0.5, -2, -6.5, -0.5, and -3 cm respectively from their initial positions, relative to the hymen's level. We observed the expected formation of stage 3 cystocele and stage 2 rectocele on the lower anterior and posterior walls. In our study, the contact pressure distribution observed at the anterior and posterior walls of the vaginal canal in the finite element model exhibited a pattern similar to the Antero-Posterior (AP) pressure profiles reported for the patient with stage 3 anterior and stage 2 posterior prolapses measured with VTI. Notably, the highest pressures at the anterior side were concentrated around the B_a point’s region. On the posterior side, peak pressures were mainly found near the A_p, B_p, and posterior fornix, which were also aligned with areas of maximum deformation in our model.
Conclusions: Our research marks a stride forward in the field of POP management. By effectively blending biomechanical simulations with clinical measurement data, our framework lays the groundwork for new methods of personalized and data-driven healthcare solutions for women suffering from POP. These enhancements aim to further personalize pessary interventions and optimize therapeutic solutions, ultimately elevating the standard of care for women with POP.
