Viscoelastic properties measurement of the prolapsed anterior vaginal wall: A patient-directed methodology

Cheng Jen Chuong, Milton Ma, Robert C. Eberhart, Philippe Zimmern

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Objective In-vivo measurement of the viscoelastic properties of the prolapsed anterior vaginal wall (AVW) in post-menopausal women undergoing cystocele repair. Study design A BTC-2000™ cutometer-like instrument was introduced during vaginal repair of symptomatic stage 2-3 AVW prolapse. Under anesthesia, 10-mm orifice probe was applied to the AVW at the level of the bladder neck. A suction pressure ramp (0 to -147 mmHg in 6 s) was delivered causing tissue uplift, followed by immediate release to 0 mmHg, measuring tissue relaxation for 20 s. Similar measurements were performed over the suprapubic region (SP) for comparison purpose. The rate of tissue recovery was obtained by fitting a Voigt model to the data and expressing results as the ratio E/η [(spring modulus E)/(dashpot viscosity η)]. The effective strain energy (SE) was calculated from the pressure-uplift data and evaluated from initiation to: (1) maximum storage in tissue at peak vacuum; (2) tissue recovery after vacuum release; (3) net SE loss over the entire loading-unloading cycle. Results In 22 women, higher AVW peak and residual tissue uplift values, and lower E/η ratios were found compared with SP results. The AVW stored less elastic strain energy at peak vacuum than did the SP, and AVW net energy loss over the uplift-recovery cycle was greater than for SP controls. Not only was the AVW more compliant than the SP, with higher viscous damping, but the tissue was also less able to store recoverable energy upon distension. Conclusion Such in-vivo measurements quantify the biomechanical properties of the prolapsed AVW and may assist in its management.

Original languageEnglish (US)
Pages (from-to)106-112
Number of pages7
JournalEuropean Journal of Obstetrics Gynecology and Reproductive Biology
Volume173
Issue number1
DOIs
StatePublished - Feb 2014

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Vacuum
Cystocele
Uterine Prolapse
Pressure
Architectural Accessibility
Suction
Viscosity
Urinary Bladder
Anesthesia

Keywords

  • Pelvic organ prolapse
  • Tissue viscoelastic properties
  • Vaginal biomechanics
  • Voigt model

ASJC Scopus subject areas

  • Obstetrics and Gynecology
  • Reproductive Medicine

Cite this

Viscoelastic properties measurement of the prolapsed anterior vaginal wall : A patient-directed methodology. / Chuong, Cheng Jen; Ma, Milton; Eberhart, Robert C.; Zimmern, Philippe.

In: European Journal of Obstetrics Gynecology and Reproductive Biology, Vol. 173, No. 1, 02.2014, p. 106-112.

Research output: Contribution to journalArticle

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abstract = "Objective In-vivo measurement of the viscoelastic properties of the prolapsed anterior vaginal wall (AVW) in post-menopausal women undergoing cystocele repair. Study design A BTC-2000™ cutometer-like instrument was introduced during vaginal repair of symptomatic stage 2-3 AVW prolapse. Under anesthesia, 10-mm orifice probe was applied to the AVW at the level of the bladder neck. A suction pressure ramp (0 to -147 mmHg in 6 s) was delivered causing tissue uplift, followed by immediate release to 0 mmHg, measuring tissue relaxation for 20 s. Similar measurements were performed over the suprapubic region (SP) for comparison purpose. The rate of tissue recovery was obtained by fitting a Voigt model to the data and expressing results as the ratio E/η [(spring modulus E)/(dashpot viscosity η)]. The effective strain energy (SE) was calculated from the pressure-uplift data and evaluated from initiation to: (1) maximum storage in tissue at peak vacuum; (2) tissue recovery after vacuum release; (3) net SE loss over the entire loading-unloading cycle. Results In 22 women, higher AVW peak and residual tissue uplift values, and lower E/η ratios were found compared with SP results. The AVW stored less elastic strain energy at peak vacuum than did the SP, and AVW net energy loss over the uplift-recovery cycle was greater than for SP controls. Not only was the AVW more compliant than the SP, with higher viscous damping, but the tissue was also less able to store recoverable energy upon distension. Conclusion Such in-vivo measurements quantify the biomechanical properties of the prolapsed AVW and may assist in its management.",
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