@phdthesis{Bhattarai2018, author = {Bhattarai, Aroj}, title = {Constitutive modeling of female pelvic floor dysfunctions and reconstructive surgeries using prosthetic mesh implants}, isbn = {978-3-9818074-8-6}, doi = {10.17185/duepublico/70340}, pages = {192 S.}, year = {2018}, language = {en} } @inproceedings{BhattaraiFrotscherSoraetal.2014, author = {Bhattarai, Aroj and Frotscher, Ralf and Sora, M.-C. and Staat, Manfred}, title = {A 3D finite element model of the female pelvic floor for the reconstruction of urinary incontinence}, series = {11th World Congress on Computational Mechanics (WCCM XI) ; 5th European Conference on Computational Mechanics (ECCM V) ; 6th European Conference on Computational Fluid Dynamics (ECFD VI) ; July 20-25, 2014, Barcelona}, booktitle = {11th World Congress on Computational Mechanics (WCCM XI) ; 5th European Conference on Computational Mechanics (ECCM V) ; 6th European Conference on Computational Fluid Dynamics (ECFD VI) ; July 20-25, 2014, Barcelona}, editor = {Onate, E.}, organization = {World Congress on Computational Mechanics <11, 2014, Barcelona>}, pages = {1 -- 12}, year = {2014}, language = {en} } @inproceedings{BhattaraiFrotscherStaat2015, author = {Bhattarai, Aroj and Frotscher, Ralf and Staat, Manfred}, title = {Biomechanical study of the female pelvic floor dysfunction using the finite element method}, series = {Conference proceedings of the YIC GACM 2015 : 3rd ECCOMAS Young Investigators Conference and 6th GACM Colloquium on Computational Mechanics , Aachen , Germany, 20.07.2015 - 23.07.2015 / ed.: Stefanie Elgeti ; Jaan-Willem Simon}, booktitle = {Conference proceedings of the YIC GACM 2015 : 3rd ECCOMAS Young Investigators Conference and 6th GACM Colloquium on Computational Mechanics , Aachen , Germany, 20.07.2015 - 23.07.2015 / ed.: Stefanie Elgeti ; Jaan-Willem Simon}, publisher = {RWTH Aachen University}, address = {Aachen}, organization = {ECCOMAS Young Investigators Conference <3, 2015, Aachen>}, pages = {1 -- 4}, year = {2015}, language = {en} } @inproceedings{BhattaraiFrotscherStaat2016, author = {Bhattarai, Aroj and Frotscher, Ralf and Staat, Manfred}, title = {Significance of fibre geometry on passive-active response of pelvic muscles to evaluate pelvic dysfunction}, series = {BioMedWomen: Proceedings of the international conference on clinical and bioengineering for women's health}, booktitle = {BioMedWomen: Proceedings of the international conference on clinical and bioengineering for women's health}, editor = {Natal Jorge, Renato}, publisher = {CRC Press}, address = {Boca Raton}, isbn = {978-1-138-02910-1}, pages = {185 -- 188}, year = {2016}, 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{BhattaraiHorbachStaatetal.2022, author = {Bhattarai, Aroj and Horbach, Andreas and Staat, Manfred and Kowalczyk, Wojciech and Tran, Thanh Ngoc}, title = {Virgin passive colon biomechanics and a literature review of active contraction constitutive models}, series = {Biomechanics}, volume = {2}, journal = {Biomechanics}, number = {2}, publisher = {MDPI}, address = {Basel}, issn = {2673-7078}, doi = {10.3390/biomechanics2020013}, pages = {138 -- 157}, year = {2022}, abstract = {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.}, language = {en} } @article{BhattaraiJabbariAndingetal.2018, author = {Bhattarai, Aroj and Jabbari, Medisa and Anding, Ralf and Staat, Manfred}, title = {Surgical treatment of vaginal vault prolapse using different prosthetic mesh implants: a finite element analysis}, series = {tm - Technisches Messen}, volume = {85}, journal = {tm - Technisches Messen}, number = {5}, publisher = {De Gruyter}, address = {Berlin}, issn = {2196-7113}, doi = {10.1515/teme-2017-0115}, pages = {331 -- 342}, year = {2018}, abstract = {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 {\"a}ltere, mehrgeb{\"a}hrende Frauen leiden h{\"a}ufiger an einem Scheidenvorfall nach einer Hysterektomie aufgrund der schwachen Unterst{\"u}tzung durch laxe apikale B{\"a}nder. Es wird angenommen, dass eine verringerte Menge an {\"O}strogen und Progesteron im h{\"o}heren Alter das Kollagen umformt, wodurch die Gewebesteifigkeit reduziert wird. Die Sakrokolpopexie ist eine offene oder laparoskopische Operation, die mit prothetischen Netzimplantaten durchgef{\"u}hrt wird, um laxe B{\"a}nder zu ersetzen. Y-f{\"o}rmige 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 w{\"a}hrend des Valsalva-Man{\"o}vers mit geschw{\"a}chtem Gewebe durchgef{\"u}hrt, das durch eine reduzierte Gewebesteifigkeit modelliert wird. Die Gewebe werden als inkompressible, isotrop hyperelastische Materialien modelliert, w{\"a}hrend die Netze entweder als orthotrope linear elastische oder als isotrope hyperlastische Materialien modelliert werden. Die Positionen des Vaginalstumpfs, der Blase und der Harnr{\"o}hrenachse werden anhand der Pubococcygeallinie aus der Ruhelage, f{\"u}r den Prolaps und nach der Reparatur unter Verwendung der drei Netze berechnet. Aufgrund der Netzmechanik und der Netzporenverformung bietet das DynaMesh mit regelm{\"a}ßigen rechteckigen Netzporen eine bessere mechanische Unterst{\"u}tzung und eine Neupositionierung des Scheidengew{\"o}lbes, der Blase und der Urethraachse als Gynemesh und Ultrapro mit unregelm{\"a}ßigen hexagonalen Netzporen.}, language = {en} } @article{BhattaraiMayStaatetal.2022, author = {Bhattarai, Aroj and May, Charlotte Anabell and Staat, Manfred and Kowalczyk, Wojciech and Tran, Thanh Ngoc}, title = {Layer-specific damage modeling of porcine large intestine under biaxial tension}, series = {Bioengineering}, volume = {9}, journal = {Bioengineering}, number = {10, Early Access}, publisher = {MDPI}, address = {Basel}, issn = {2306-5354}, doi = {10.3390/bioengineering9100528}, pages = {1 -- 17}, year = {2022}, abstract = {The mechanical behavior of the large intestine beyond the ultimate stress has never been investigated. Stretching beyond the ultimate stress may drastically impair the tissue microstructure, which consequently weakens its healthy state functions of absorption, temporary storage, and transportation for defecation. Due to closely similar microstructure and function with humans, biaxial tensile experiments on the porcine large intestine have been performed in this study. In this paper, we report hyperelastic characterization of the large intestine based on experiments in 102 specimens. We also report the theoretical analysis of the experimental results, including an exponential damage evolution function. The fracture energies and the threshold stresses are set as damage material parameters for the longitudinal muscular, the circumferential muscular and the submucosal collagenous layers. A biaxial tensile simulation of a linear brick element has been performed to validate the applicability of the estimated material parameters. The model successfully simulates the biomechanical response of the large intestine under physiological and non-physiological loads.}, language = {en} } @inproceedings{BhattaraiStaat2016, author = {Bhattarai, Aroj and Staat, Manfred}, title = {Female pelvic floor dysfunction: progress weakening of the support system}, series = {1st YRA MedTech Symposium 2016 : April 8th / 2016 / University of Duisburg-Essen}, booktitle = {1st YRA MedTech Symposium 2016 : April 8th / 2016 / University of Duisburg-Essen}, editor = {Erni, Daniel}, publisher = {Universit{\"a}t Duisburg-Essen}, address = {Duisburg}, organization = {MedTech Symposium}, doi = {10.17185/duepublico/40821}, pages = {11 -- 12}, year = {2016}, abstract = {The structure of the female pelvic floor (PF) is an inter-related system of bony pelvis,muscles, pelvic organs, fascias, ligaments, and nerves with multiple functions. Mechanically, thepelvic organ support system are of two types: (I) supporting system of the levator ani (LA) muscle,and (II) the suspension system of the endopelvic fascia condensation [1], [2]. Significantdenervation injury to the pelvic musculature, depolimerization of the collagen fibrils of the softvaginal hammock, cervical ring and ligaments during pregnancy and vaginal delivery weakens thenormal functions of the pelvic floor. Pelvic organ prolapse, incontinence, sexual dysfunction aresome of the dysfunctions which increases progressively with age and menopause due toweakened support system according to the Integral theory [3]. An improved 3D finite elementmodel of the female pelvic floor as shown in Fig. 1 is constructed that: (I) considers the realisticsupport of the organs to the pelvic side walls, (II) employs the improvement of our previous FEmodel [4], [5] along with the patient based geometries, (III) incorporates the realistic anatomy andboundary conditions of the endopelvic (pubocervical and rectovaginal) fascia, and (IV) considersvarying stiffness of the endopelvic fascia in the craniocaudal direction [3]. Several computationsare carried out on the presented computational model with healthy and damaged supportingtissues, and comparisons are made to understand the physiopathology of the female PF disorders.}, language = {en} } @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} }