The single-incision sling to treat female stress urinary incontinence: A dynamic computational study of outcomes and risk factors

Yun Peng, Rose Khavari, Nissrine A Nakib, Julie N. Stewart, Timothy B. Boone, Yingchun Zhang

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Dynamic behaviors of the single-incision sling (SIS) to correct urethral hypermobility are investigated via dynamic biomechanical analysis using a computational model of the female pelvis, developed from a female subject's high-resolution magnetic resonance (MR) images. The urethral hypermobility is simulated by weakening the levator ani muscle in the pelvic model. Four positions along the posterior urethra (proximal, midproximal, middle, and mid-distal) were considered for sling implantation. The α-angle, urethral excursion angle, and sling-urethra interaction force generated during Valsalva maneuver were quantitatively characterized to evaluate the effect of the sling implantation position on treatment outcomes and potential complications. Results show concern for overcorrection with a sling implanted at the bladder neck, based on a relatively larger sling-urethra interaction force of 1.77 N at the proximal implantation position (compared with 0.25 N at mid-distal implantation position). A sling implanted at the mid-distal urethral location provided sufficient correction (urethral excursion angle of 23.8 deg after mid-distal sling implantation versus 24.4 deg in the intact case) with minimal risk of overtightening and represents the optimal choice for sling surgery. This study represents the first effort utilizing a comprehensive pelvic model to investigate the performance of an implanted sling to correct urethral hypermobility. The computational modeling approach presented in the study can also be used to advance presurgery planning, sling product design, and to enhance our understanding of various surgical risk factors which are difficult to obtain in clinical practice.

Original languageEnglish (US)
Article number91007
JournalJournal of Biomechanical Engineering
Volume137
Issue number9
DOIs
StatePublished - Sep 1 2015

Fingerprint

Slings
Stress Urinary Incontinence
Urethra
Outcome Assessment (Health Care)
Valsalva Maneuver
Anal Canal
Pelvis
Urinary Bladder
Magnetic Resonance Spectroscopy
Muscles
Magnetic resonance
Product design
Dynamic analysis
Surgery
Muscle

Keywords

  • Stress urinary incontinence
  • finite-element method
  • modeling
  • sling

Cite this

The single-incision sling to treat female stress urinary incontinence : A dynamic computational study of outcomes and risk factors. / Peng, Yun; Khavari, Rose; Nakib, Nissrine A; Stewart, Julie N.; Boone, Timothy B.; Zhang, Yingchun.

In: Journal of Biomechanical Engineering, Vol. 137, No. 9, 91007, 01.09.2015.

Research output: Contribution to journalArticle

@article{efe368e0ae2c4b4da303580e084fa5a2,
title = "The single-incision sling to treat female stress urinary incontinence: A dynamic computational study of outcomes and risk factors",
abstract = "Dynamic behaviors of the single-incision sling (SIS) to correct urethral hypermobility are investigated via dynamic biomechanical analysis using a computational model of the female pelvis, developed from a female subject's high-resolution magnetic resonance (MR) images. The urethral hypermobility is simulated by weakening the levator ani muscle in the pelvic model. Four positions along the posterior urethra (proximal, midproximal, middle, and mid-distal) were considered for sling implantation. The α-angle, urethral excursion angle, and sling-urethra interaction force generated during Valsalva maneuver were quantitatively characterized to evaluate the effect of the sling implantation position on treatment outcomes and potential complications. Results show concern for overcorrection with a sling implanted at the bladder neck, based on a relatively larger sling-urethra interaction force of 1.77 N at the proximal implantation position (compared with 0.25 N at mid-distal implantation position). A sling implanted at the mid-distal urethral location provided sufficient correction (urethral excursion angle of 23.8 deg after mid-distal sling implantation versus 24.4 deg in the intact case) with minimal risk of overtightening and represents the optimal choice for sling surgery. This study represents the first effort utilizing a comprehensive pelvic model to investigate the performance of an implanted sling to correct urethral hypermobility. The computational modeling approach presented in the study can also be used to advance presurgery planning, sling product design, and to enhance our understanding of various surgical risk factors which are difficult to obtain in clinical practice.",
keywords = "Stress urinary incontinence, finite-element method, modeling, sling",
author = "Yun Peng and Rose Khavari and Nakib, {Nissrine A} and Stewart, {Julie N.} and Boone, {Timothy B.} and Yingchun Zhang",
year = "2015",
month = "9",
day = "1",
doi = "10.1115/1.4030978",
language = "English (US)",
volume = "137",
journal = "Journal of Biomechanical Engineering",
issn = "0148-0731",
publisher = "American Society of Mechanical Engineers(ASME)",
number = "9",

}

TY - JOUR

T1 - The single-incision sling to treat female stress urinary incontinence

T2 - A dynamic computational study of outcomes and risk factors

AU - Peng, Yun

AU - Khavari, Rose

AU - Nakib, Nissrine A

AU - Stewart, Julie N.

AU - Boone, Timothy B.

AU - Zhang, Yingchun

PY - 2015/9/1

Y1 - 2015/9/1

N2 - Dynamic behaviors of the single-incision sling (SIS) to correct urethral hypermobility are investigated via dynamic biomechanical analysis using a computational model of the female pelvis, developed from a female subject's high-resolution magnetic resonance (MR) images. The urethral hypermobility is simulated by weakening the levator ani muscle in the pelvic model. Four positions along the posterior urethra (proximal, midproximal, middle, and mid-distal) were considered for sling implantation. The α-angle, urethral excursion angle, and sling-urethra interaction force generated during Valsalva maneuver were quantitatively characterized to evaluate the effect of the sling implantation position on treatment outcomes and potential complications. Results show concern for overcorrection with a sling implanted at the bladder neck, based on a relatively larger sling-urethra interaction force of 1.77 N at the proximal implantation position (compared with 0.25 N at mid-distal implantation position). A sling implanted at the mid-distal urethral location provided sufficient correction (urethral excursion angle of 23.8 deg after mid-distal sling implantation versus 24.4 deg in the intact case) with minimal risk of overtightening and represents the optimal choice for sling surgery. This study represents the first effort utilizing a comprehensive pelvic model to investigate the performance of an implanted sling to correct urethral hypermobility. The computational modeling approach presented in the study can also be used to advance presurgery planning, sling product design, and to enhance our understanding of various surgical risk factors which are difficult to obtain in clinical practice.

AB - Dynamic behaviors of the single-incision sling (SIS) to correct urethral hypermobility are investigated via dynamic biomechanical analysis using a computational model of the female pelvis, developed from a female subject's high-resolution magnetic resonance (MR) images. The urethral hypermobility is simulated by weakening the levator ani muscle in the pelvic model. Four positions along the posterior urethra (proximal, midproximal, middle, and mid-distal) were considered for sling implantation. The α-angle, urethral excursion angle, and sling-urethra interaction force generated during Valsalva maneuver were quantitatively characterized to evaluate the effect of the sling implantation position on treatment outcomes and potential complications. Results show concern for overcorrection with a sling implanted at the bladder neck, based on a relatively larger sling-urethra interaction force of 1.77 N at the proximal implantation position (compared with 0.25 N at mid-distal implantation position). A sling implanted at the mid-distal urethral location provided sufficient correction (urethral excursion angle of 23.8 deg after mid-distal sling implantation versus 24.4 deg in the intact case) with minimal risk of overtightening and represents the optimal choice for sling surgery. This study represents the first effort utilizing a comprehensive pelvic model to investigate the performance of an implanted sling to correct urethral hypermobility. The computational modeling approach presented in the study can also be used to advance presurgery planning, sling product design, and to enhance our understanding of various surgical risk factors which are difficult to obtain in clinical practice.

KW - Stress urinary incontinence

KW - finite-element method

KW - modeling

KW - sling

UR - http://www.scopus.com/inward/record.url?scp=84937202391&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84937202391&partnerID=8YFLogxK

U2 - 10.1115/1.4030978

DO - 10.1115/1.4030978

M3 - Article

C2 - 26142123

AN - SCOPUS:84937202391

VL - 137

JO - Journal of Biomechanical Engineering

JF - Journal of Biomechanical Engineering

SN - 0148-0731

IS - 9

M1 - 91007

ER -