TY - JOUR A1 - Bhattarai, Aroj A1 - Staat, Manfred T1 - Modelling of Soft Connective Tissues to Investigate Female Pelvic Floor Dysfunctions JF - Computational and Mathematical Methods in Medicine N2 - After menopause, decreased levels of estrogen and progesterone remodel the collagen of the soft tissues thereby reducing their stiffness. Stress urinary incontinence is associated with involuntary urine leakage due to pathological movement of the pelvic organs resulting from lax suspension system, fasciae, and ligaments. This study compares the changes in the orientation and position of the female pelvic organs due to weakened fasciae, ligaments, and their combined laxity. A mixture theory weighted by respective volume fraction of elastin-collagen fibre compound (5%), adipose tissue (85%), and smooth muscle (5%) is adopted to characterize the mechanical behaviour of the fascia. The load carrying response (other than the functional response to the pelvic organs) of each fascia component, pelvic organs, muscles, and ligaments are assumed to be isotropic, hyperelastic, and incompressible. Finite element simulations are conducted during Valsalva manoeuvre with weakened tissues modelled by reduced tissue stiffness. A significant dislocation of the urethrovesical junction is observed due to weakness of the fascia (13.89 mm) compared to the ligaments (5.47 mm). The dynamics of the pelvic floor observed in this study during Valsalva manoeuvre is associated with urethral-bladder hypermobility, greater levator plate angulation, and positive Q-tip test which are observed in incontinent females. Y1 - 2018 U6 - http://dx.doi.org/10.1155/2018/9518076 SN - 1748-6718 VL - 2018 IS - Article ID 9518076 SP - 1 EP - 16 PB - Hindawi CY - New York, NY ER - TY - CHAP A1 - Bhattarai, Aroj A1 - Staat, Manfred ED - Fernandes, P.R. ED - Tavares, J. M. T1 - Pectopexy to repair vaginal vault prolapse: a finite element approach T2 - Proceedings CMBBE 2018 N2 - The vaginal prolapse after hysterectomy (removal of the uterus) is often associated with the prolapse of the vaginal vault, rectum, bladder, urethra or small bowel. Minimally invasive surgery such as laparoscopic sacrocolpopexy and pectopexy are widely performed for the treatment of the vaginal prolapse with weakly supported vaginal vault after hysterectomy using prosthetic mesh implants to support (or strengthen) lax apical ligaments. Implants of different shape, size and polymers are selected depending on the patient’s anatomy and the surgeon’s preference. In this computational study on pectopexy, DynaMesh®-PRP soft, GYNECARE GYNEMESH® PS Nonabsorbable PROLENE® soft and Ultrapro® are tested in a 3D finite element model of the female pelvic floor. The mesh model is implanted into the extraperitoneal space and sutured to the vaginal stump with a bilateral fixation to the iliopectineal ligament at both sides. Numerical simulations are conducted at rest, after surgery and during Valsalva maneuver with weakened tissues modeled by reduced tissue stiffness. Tissues and prosthetic meshes are modeled as incompressible, isotropic hyperelastic materials. The positions of the organs are calculated with respect to the pubococcygeal line (PCL) for female pelvic floor at rest, after repair and during Valsalva maneuver using the three meshes. Y1 - 2018 N1 - 15th International Symposium on Computer Methods in Biomechanics and Biomedical Engineering and 3rd Conference on Imaging and Visualization. CMBBE 2018. 26-29 March 2018, Lisbon, Portugal ER - TY - RPRT A1 - Bhattarai, Aroj A1 - Frotscher, Ralf A1 - Durong, Minh Tuán A1 - Staat, Manfred T1 - Schlussbericht zu BINGO. Optimierung des Systems Netzimplantat-Beckenboden zur therapeutischen Gewebeverstärkung nach der Integraltheorie. Y1 - 2016 N1 - Förderkennzeichen BMBF 03FH073PX2 CY - Aachen ER - TY - CHAP A1 - Bhattarai, Aroj A1 - Frotscher, Ralf A1 - Staat, Manfred ED - Natal Jorge, Renato T1 - Significance of fibre geometry on passive-active response of pelvic muscles to evaluate pelvic dysfunction T2 - BioMedWomen: Proceedings of the international conference on clinical and bioengineering for women's health Y1 - 2016 SN - 978-1-138-02910-1 SP - 185 EP - 188 PB - CRC Press CY - Boca Raton ER - TY - JOUR A1 - Bhattarai, Aroj A1 - Jabbari, Medisa A1 - Anding, Ralf A1 - Staat, Manfred T1 - Surgical treatment of vaginal vault prolapse using different prosthetic mesh implants: a finite element analysis JF - tm - Technisches Messen N2 - Particularly multiparous elderly women may suffer from vaginal vault prolapse after hysterectomy due to weak support from lax apical ligaments. A decreased amount of estrogen and progesterone in older age is assumed to remodel the collagen thereby reducing tissue stiffness. Sacrocolpopexy is either performed as open or laparoscopic surgery using prosthetic mesh implants to substitute lax ligaments. Y-shaped mesh models (DynaMesh, Gynemesh, and Ultrapro) are implanted in a 3D female pelvic floor finite element model in the extraperitoneal space from the vaginal cuff to the first sacral (S1) bone below promontory. Numerical simulations are conducted during Valsalva maneuver with weakened tissues modeled by reduced tissue stiffness. Tissues are modeled as incompressible, isotropic hyperelastic materials whereas the meshes are modeled either as orthotropic linear elastic or as isotropic hyperlastic materials. The positions of the vaginal cuff and the bladder base are calculated from the pubococcygeal line for female pelvic floor at rest, for prolapse and after repair using the three meshes. Due to mesh mechanics and mesh pore deformation along the loaded direction, the DynaMesh with regular rectangular mesh pores is found to provide better mechanical support to the organs than the Gynemesh and the Ultrapro with irregular hexagonal mesh pores. Insbesondere ältere, mehrgebährende Frauen leiden häufiger an einem Scheidenvorfall nach einer Hysterektomie aufgrund der schwachen Unterstützung durch laxe apikale Bänder. Es wird angenommen, dass eine verringerte Menge an Östrogen und Progesteron im höheren Alter das Kollagen umformt, wodurch die Gewebesteifigkeit reduziert wird. Die Sakrokolpopexie ist eine offene oder laparoskopische Operation, die mit prothetischen Netzimplantaten durchgeführt wird, um laxe Bänder zu ersetzen. Y-förmige Netzmodelle (DynaMesh, Gynemesh und Ultrapro) werden in einem 3D-Modell des weiblichen Beckenbodens im extraperitonealen Raum vom Vaginalstumpf bis zum Promontorium implantiert. Numerische Simulationen werden während des Valsalva-Manövers mit geschwächtem Gewebe durchgeführt, das durch eine reduzierte Gewebesteifigkeit modelliert wird. Die Gewebe werden als inkompressible, isotrop hyperelastische Materialien modelliert, während die Netze entweder als orthotrope linear elastische oder als isotrope hyperlastische Materialien modelliert werden. Die Positionen des Vaginalstumpfs, der Blase und der Harnröhrenachse werden anhand der Pubococcygeallinie aus der Ruhelage, für den Prolaps und nach der Reparatur unter Verwendung der drei Netze berechnet. Aufgrund der Netzmechanik und der Netzporenverformung bietet das DynaMesh mit regelmäßigen rechteckigen Netzporen eine bessere mechanische Unterstützung und eine Neupositionierung des Scheidengewölbes, der Blase und der Urethraachse als Gynemesh und Ultrapro mit unregelmäßigen hexagonalen Netzporen. Y1 - 2018 U6 - http://dx.doi.org/10.1515/teme-2017-0115 SN - 2196-7113 VL - 85 IS - 5 SP - 331 EP - 342 PB - De Gruyter CY - Berlin ER - TY - JOUR A1 - Bhattarai, Aroj A1 - Horbach, Andreas A1 - Staat, Manfred A1 - Kowalczyk, Wojciech A1 - Tran, Thanh Ngoc T1 - Virgin passive colon biomechanics and a literature review of active contraction constitutive models JF - Biomechanics N2 - The objective of this paper is to present our findings on the biomechanical aspects of the virgin passive anisotropic hyperelasticity of the porcine colon based on equibiaxial tensile experiments. Firstly, the characterization of the intestine tissues is discussed for a nearly incompressible hyperelastic fiber-reinforced Holzapfel–Gasser–Ogden constitutive model in virgin passive loading conditions. The stability of the evaluated material parameters is checked for the polyconvexity of the adopted strain energy function using positive eigenvalue constraints of the Hessian matrix with MATLAB. The constitutive material description of the intestine with two collagen fibers in the submucosal and muscular layer each has been implemented in the FORTRAN platform of the commercial finite element software LS-DYNA, and two equibiaxial tensile simulations are presented to validate the results with the optical strain images obtained from the experiments. Furthermore, this paper also reviews the existing models of the active smooth muscle cells, but these models have not been computationally studied here. The review part shows that the constitutive models originally developed for the active contraction of skeletal muscle based on Hill’s three-element model, Murphy’s four-state cross-bridge chemical kinetic model and Huxley’s sliding-filament hypothesis, which are mainly used for arteries, are appropriate for numerical contraction numerical analysis of the large intestine. KW - virgin passive KW - strain energy function KW - smooth muscle contraction KW - viscoelasticity KW - damage Y1 - 2022 U6 - http://dx.doi.org/10.3390/biomechanics2020013 SN - 2673-7078 VL - 2 IS - 2 SP - 138 EP - 157 PB - MDPI CY - Basel ER -