Biomechanics: Combining engineering and clinical experience to improve treatment of female pelvic organ prolapse
30-04-2020
Article by João Ferreira, researcher at INEGI in the area of Biomechanics and Health
Female pelvic organ prolapse annually affects and threatens the well-being of ~7k women in Portugal, with concerning annual increase rates. As women have children and age, their chances of developing prolapse increase dramatically. Since aged women are increasing in Portugal, it expected an increase of 40% in annual instances over the next 40 years.
Women with prolapse have weak and loose muscles and tissues, which causes the organs to and protrude the vagina. This loss of support may lead to a bulge in the vagina that can sometimes be felt or seen. Thus, women with prolapse feel uncomfortable daily, if not treated. Still, many are embarrassed to talk to their doctor about it, convincing themselves that their symptoms are typical with aging. Those that express concerns to the doctor are asked to strain or cough as an examination routine. Follow-up tests make sure that the correct treatment is addressed to the patient.
Pessaries are often the first treatment that doctors try. These are removable devices of many sizes and shapes that, when ed into the vagina, support the pelvic organs. Also, doctors always recommend pelvic floor exercises to help strengthen the muscles. Ultimately, surgery to build pelvic support can be done, either using body tissue or synthetic meshes. Both options can bring many unfortunate complications after surgery. These surgical repairs provide anatomical restitution but do not address the underlying cause of pelvic organ prolapse, which remains elusive.
Because of these difficulties, better options have been in development in the last years. The researchers of INEGI’s biomechanics group have been dedicated to improving the quality of life of women through the development of new ways to prevent and treat pelvic organ prolapse.
In this area, we aim to combine our engineering skills and the medical knowledge of clinicians focused on female pelvic floor dysfunction, including urologists, gynecologists, and maternal fetal medicine specialists, to better understand how to treat this condition.
CELL-BASED APPROACHES CAN DRIVE THE SUCCESS OF TREATMENT
New computational and engineering approaches have been focused on helping the therapeutic success and better individual planning, specific for each patient. The acquired knowledge by the group increased the understanding of the pelvic system, relating forces, behavior, and properties of many pelvic tissues and organs.
As the major risk for prolapse, vaginal birth delivery provides an opportunity to understand how this pathology develops and how to improve current medical interventions. Our experimental studies, in collaboration with KU Leuven (Belgium), demonstrated that, during pregnancy, most of the pelvic tissues change their properties, likely to minimize injury for delivery. This incredible adaptation by women, however, it is not sufficient to prevent damage, which may lead to prolapse decades later. It is estimated that 10% of women that naturally delivered will need surgery for prolapse.
More recently, and in collaboration with Cleveland Clinic’s premier research labs in urology (OH, USA), we have found evidence of altered mechanics of the muscle cells from animals with prolapse. This fascinating discovery may explain why the pelvic tissues become weak postpartum.
As surgical meshes are continuously being banned from many countries over the world, new tissue-engineering and regenerative interventions may be the next step. In which, studies at the cellular scale have been significant in optimizing regenerative strategies to maintain the pelvic system healthy.
The experience and weighing of the physicians will always be of utmost importance in making decisions on how to treat a patient with prolapse. In this context, the combination of our expertise may be the key to drive the creation of a comprehensive view of female pelvic floor biomechanics in order to develop new technologies and provide better options for treatment.
Mascarenhas, T., Mascarenhas-Saraiva, M., Ricon-Ferraz, A. et al. Pelvic organ prolapse surgical management in Portugal and FDA safety communication have an impact on vaginal mesh. Int Urogynecol J 26, 113–122 (2015). https://doi.org/10.1007/s00192-014-2480-0
Rynkevic, Rita and Ferreira, João and Martins, Pedro and Parente, Marco and Fernandes, Antonio A. "Linking hyperelastic theoretical models and experimental data of vaginal tissue through histological data". Journal of Biomechanics 82.3 (January 2019), DOI: https://doi.org/10.1016/j.jbiomech.2018.10.038
João P. S. Ferreira, Mei Kuang, Marco P. L. Parente, Renato M. Natal Jorge, R. Wang, S. J. Eppell and Margot S. Damaser. "Altered mechanics of vaginal smooth muscle cells due to the lysyl oxidase-like1 knockout". Acta Biomaterialia x.x (April 2020), DOI: https://doi.org/10.1016/j.actbio.2020.03.046
Female pelvic organ prolapse annually affects and threatens the well-being of ~7k women in Portugal, with concerning annual increase rates. As women have children and age, their chances of developing prolapse increase dramatically. Since aged women are increasing in Portugal, it expected an increase of 40% in annual instances over the next 40 years.
Women with prolapse have weak and loose muscles and tissues, which causes the organs to and protrude the vagina. This loss of support may lead to a bulge in the vagina that can sometimes be felt or seen. Thus, women with prolapse feel uncomfortable daily, if not treated. Still, many are embarrassed to talk to their doctor about it, convincing themselves that their symptoms are typical with aging. Those that express concerns to the doctor are asked to strain or cough as an examination routine. Follow-up tests make sure that the correct treatment is addressed to the patient.
Pessaries are often the first treatment that doctors try. These are removable devices of many sizes and shapes that, when ed into the vagina, support the pelvic organs. Also, doctors always recommend pelvic floor exercises to help strengthen the muscles. Ultimately, surgery to build pelvic support can be done, either using body tissue or synthetic meshes. Both options can bring many unfortunate complications after surgery. These surgical repairs provide anatomical restitution but do not address the underlying cause of pelvic organ prolapse, which remains elusive.
Because of these difficulties, better options have been in development in the last years. The researchers of INEGI’s biomechanics group have been dedicated to improving the quality of life of women through the development of new ways to prevent and treat pelvic organ prolapse.
In this area, we aim to combine our engineering skills and the medical knowledge of clinicians focused on female pelvic floor dysfunction, including urologists, gynecologists, and maternal fetal medicine specialists, to better understand how to treat this condition.
CELL-BASED APPROACHES CAN DRIVE THE SUCCESS OF TREATMENT
New computational and engineering approaches have been focused on helping the therapeutic success and better individual planning, specific for each patient. The acquired knowledge by the group increased the understanding of the pelvic system, relating forces, behavior, and properties of many pelvic tissues and organs.
As the major risk for prolapse, vaginal birth delivery provides an opportunity to understand how this pathology develops and how to improve current medical interventions. Our experimental studies, in collaboration with KU Leuven (Belgium), demonstrated that, during pregnancy, most of the pelvic tissues change their properties, likely to minimize injury for delivery. This incredible adaptation by women, however, it is not sufficient to prevent damage, which may lead to prolapse decades later. It is estimated that 10% of women that naturally delivered will need surgery for prolapse.
More recently, and in collaboration with Cleveland Clinic’s premier research labs in urology (OH, USA), we have found evidence of altered mechanics of the muscle cells from animals with prolapse. This fascinating discovery may explain why the pelvic tissues become weak postpartum.
As surgical meshes are continuously being banned from many countries over the world, new tissue-engineering and regenerative interventions may be the next step. In which, studies at the cellular scale have been significant in optimizing regenerative strategies to maintain the pelvic system healthy.
The experience and weighing of the physicians will always be of utmost importance in making decisions on how to treat a patient with prolapse. In this context, the combination of our expertise may be the key to drive the creation of a comprehensive view of female pelvic floor biomechanics in order to develop new technologies and provide better options for treatment.
Mascarenhas, T., Mascarenhas-Saraiva, M., Ricon-Ferraz, A. et al. Pelvic organ prolapse surgical management in Portugal and FDA safety communication have an impact on vaginal mesh. Int Urogynecol J 26, 113–122 (2015). https://doi.org/10.1007/s00192-014-2480-0
Rynkevic, Rita and Ferreira, João and Martins, Pedro and Parente, Marco and Fernandes, Antonio A. "Linking hyperelastic theoretical models and experimental data of vaginal tissue through histological data". Journal of Biomechanics 82.3 (January 2019), DOI: https://doi.org/10.1016/j.jbiomech.2018.10.038
João P. S. Ferreira, Mei Kuang, Marco P. L. Parente, Renato M. Natal Jorge, R. Wang, S. J. Eppell and Margot S. Damaser. "Altered mechanics of vaginal smooth muscle cells due to the lysyl oxidase-like1 knockout". Acta Biomaterialia x.x (April 2020), DOI: https://doi.org/10.1016/j.actbio.2020.03.046
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