@article{BhattaraiStaat2018,
  author    = {Bhattarai, Aroj and Staat, Manfred},
  title     = {Modelling of Soft Connective Tissues to Investigate Female Pelvic Floor Dysfunctions},
  series = {Computational and Mathematical Methods in Medicine},
  volume    = {2018},
  journal   = {Computational and Mathematical Methods in Medicine},
  number    = {Article ID 9518076},
  publisher = {Hindawi},
  address   = {New York, NY},
  issn      = {1748-6718},
  doi       = {10.1155/2018/9518076},
  pages     = {1 -- 16},
  year      = {2018},
  abstract  = {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.},
  language  = {en}
}
@incollection{BhattaraiFrotscherStaat2018,
  author    = {Bhattarai, Aroj and Frotscher, Ralf and Staat, Manfred},
  title     = {Computational Analysis of Pelvic Floor Dysfunction},
  series = {Women's Health and Biomechanics},
  booktitle = {Women's Health and Biomechanics},
  publisher = {Springer},
  address   = {Cham},
  isbn      = {978-3-319-71574-2},
  doi       = {10.1007/978-3-319-71574-2_17},
  pages     = {217 -- 230},
  year      = {2018},
  abstract  = {Pelvic floor dysfunction (PFD) is characterized by the failure of the levator ani (LA) muscle to maintain the pelvic hiatus, resulting in the descent of the pelvic organs below the pubococcygeal line. This chapter adopts the modified Humphrey material model to consider the effect of the muscle fiber on passive stretching of the LA muscle. The deformation of the LA muscle subjected to intra-abdominal pressure during Valsalva maneuver is compared with the magnetic resonance imaging (MRI) examination of a nulliparous female. Numerical result shows that the fiber-based Humphrey model simulates the muscle behavior better than isotropic constitutive models. Greater posterior movement of the LA muscle widens the levator hiatus due to lack of support from the anococcygeal ligament and the perineal structure as a consequence of birth-related injury and aging. Old and multiparous females with uncontrolled urogenital and rectal hiatus tend to develop PFDs such as prolapse and incontinence.},
  language  = {en}
}
@article{CiritsisHorbachStaatetal.2018,
  author    = {Ciritsis, Alexander and Horbach, Andreas and Staat, Manfred and Kuhl, Christiane K. and Kraemer, Nils Andreas},
  title     = {Porosity and tissue integration of elastic mesh implants evaluated in vitro and in vivo},
  series = {Journal of Biomedical Materials Research: Part B: Applied Biomaterials},
  volume    = {106},
  journal   = {Journal of Biomedical Materials Research: Part B: Applied Biomaterials},
  number    = {2},
  publisher = {Wiley},
  address   = {New York, NY},
  issn      = {1552-4981},
  doi       = {10.1002/jbm.b.33877},
  pages     = {827 -- 833},
  year      = {2018},
  abstract  = {Purpose In vivo, a loss of mesh porosity triggers scar tissue formation and restricts functionality. The purpose of this study was to evaluate the properties and configuration changes as mesh deformation and mesh shrinkage of a soft mesh implant compared with a conventional stiff mesh implant in vitro and in a porcine model. Material and Methods Tensile tests and digital image correlation were used to determine the textile porosity for both mesh types in vitro. A group of three pigs each were treated with magnetic resonance imaging (MRI) visible conventional stiff polyvinylidene fluoride meshes (PVDF) or with soft thermoplastic polyurethane meshes (TPU) (FEG Textiltechnik mbH, Aachen, Germany), respectively. MRI was performed with a pneumoperitoneum at a pressure of 0 and 15 mmHg, which resulted in bulging of the abdomen. The mesh-induced signal voids were semiautomatically segmented and the mesh areas were determined. With the deformations assessed in both mesh types at both pressure conditions, the porosity change of the meshes after 8 weeks of ingrowth was calculated as an indicator of preserved elastic properties. The explanted specimens were examined histologically for the maturity of the scar (collagen I/III ratio). Results In TPU, the in vitro porosity increased constantly, in PVDF, a loss of porosity was observed under mild stresses. In vivo, the mean mesh areas of TPU were 206.8 cm2 (± 5.7 cm2) at 0 mmHg pneumoperitoneum and 274.6 cm2 (± 5.2 cm2) at 15 mmHg; for PVDF the mean areas were 205.5 cm2 (± 8.8 cm2) and 221.5 cm2 (± 11.8 cm2), respectively. The pneumoperitoneum-induced pressure increase resulted in a calculated porosity increase of 8.4\% for TPU and of 1.2\% for PVDF. The mean collagen I/III ratio was 8.7 (± 0.5) for TPU and 4.7 (± 0.7) for PVDF. Conclusion The elastic properties of TPU mesh implants result in improved tissue integration compared to conventional PVDF meshes, and they adapt more efficiently to the abdominal wall. © 2017 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 106B: 827-833, 2018.},
  language  = {en}
}