Pelvic floor disorders (PFD), including Pelvic Organ Prolapse (POP), can negatively impact a woman’s daily activities and quality of life. POP is a growing concern, with an increasing number of cases each year and significant numbers of women going through surgery to alleviate it. Traditional interventions like the use of mesh implants have certain limitations such as repeated surgeries. An alternative surgical intervention technique using injectable biodegradable cog threads was suggested. The application of Finite element analysis (FEA) to this research allows us to personalize and select suitable POP correction techniques and study the effect of alternative reinforcement techniques. The 3D computational model of the vagina will be used to simulate defect repair using cog threads. To accurately model this, we conducted uniaxial tensile tests on both the polycaprolactone (PCL) cog threads and the sow’s vaginal tissues, which mimic human tissue, providing vital data for precise finite element modeling. The study’s findings suggest that cog threads may have the potential to provide benefits in the treatment of POP. This study provides a starting point for further research on cog threads as one possible treatment option for POP.
GrobATMOlde HeuvelJFuttererJJ, et al. Underestimation of pelvic organ prolapse in the supine straining position, based on magnetic resonance imaging findings. Int Urogynecol J2019; 30(11): 1939–1944.
2.
PetrosP.The female pelvic floor: function, dysfunction and management according to the integral theory. Berlin, Heidelberg: Springer, 2006.
3.
ElneilS.Complex pelvic floor failure and associated problems. Best Pract Res Clin Gastroenterol2009; 23(4): 555–573.
4.
IglesiaCBSmithlingKR.Pelvic organ prolapse. Am Fam Physician2017; 96(3): 179–185.
RadaMPJonesSFalconiG, et al.; CHORUS: An International Collaboration for Harmonising Outcomes, Research and Standards in Urogynaecology and Women’s Health. A systematic review and meta-synthesis of qualitative studies on pelvic organ prolapse for the development of core outcome sets. Neurourol Urodyn2020; 39(3): 880–889.
7.
BarberMDMaherCG.Epidemiology and outcome assessment of pelvic organ prolapse. London: Springer, 2013. pp.24.
8.
KiyosakiKAckermanALHistedS, et al. Patients’ understanding of pelvic floor disorders. Female Pelvic Med Reconstr Surg2012; 18(3): 137–142.
9.
WuJMKawasakiAHundleyAF, et al. Predicting the number of women who will undergo incontinence and prolapse surgery, 2010 to 2050. Am J Obstet Gynecol2011; 205(3): 230.e1–230.e5.
10.
CundiffGWAmundsenCLBentAE, et al. The PESSRI study: symptom relief outcomes of a randomized crossover trial of the ring and gellhorn pessaries. Am J Obstet Gynecol2007; 196(4): 405.e1–405.e8.
11.
RappDECongletonJYBoatmanK, et al. Bilateral ureterovaginal fistulas and vesicovaginal fistula in setting of retained pessary. Urology2020; 141: e11–e13.
12.
XieMZhangXZhangX, et al. Can we evaluate the levator ani after kegel exercise in women with pelvic organ prolapse by transperineal elastography? A preliminary study. J Med Ultrason2001; 45(3): 437–441. 2018.
13.
FDA. FDA takes action to protect women’s health, orders manufacturers of surgical mesh intended for transvaginal repair of pelvic organ prolapse to stop selling all devices. FDA, 2019.
14.
RajuRLinderBJ.Evaluation and management of pelvic organ prolapse. Mayo Clin Proc2021; 96(12): 3122–3129.
15.
MascarenhasTMascarenhas-SaraivaMRicon-FerrazA, et al. Pelvic organ prolapse surgical management in portugal and FDA safety communication have an impact on vaginal mesh. Int Urogynecol J2015; 26(1): 113–122.
16.
AchtariCDwyerPL.Sexual function and pelvic floor disorders. Best Pract Res Clin Obstet Gynaecol2005; 19(6): 993–1008, quiz A1–8.
17.
GulerZRooversJP.Role of fibroblasts and myofibroblasts on the pathogenesis and treatment of pelvic organ prolapse. Biomolecules2022; 12(1): 94.
18.
HaylenBTde RidderDFreemanRM, et al.; International Urogynecological Association and International Continence Society. An international urogynecological association (IUGA)/international continence society (ICS) joint report on the terminology for female pelvic floor dysfunction. Neurourol Urodyn2010; 29(1): 4–20.
19.
DällenbachP. To mesh or not to mesh: a review of pelvic organ reconstructive surgery. Int J Womens Health2015; 7: 331–343.
20.
VashaghianMRuiz-ZapataAMKerkhofMH, et al. Toward a new generation of pelvic floor implants with electrospun nanofibrous matrices: a feasibility study. Neurourol Urodyn2017; 36(3): 565–573.
21.
OryanAAlidadiSMoshiriA, et al. Bone regenerative medicine: classic options, novel strategies, and future directions. J Orthop Surg Res2014; 9(1): 18.
WongVRafiqNKalyanR, et al. Hanging by a thread: choosing the right thread for the right patient. Dermat Cosmetol2017; 1(4): 86–88.
24.
LeeCGJungJHwangS, et al. Histological evaluation of bioresorbable threads in rats. Korean J Clin Lab Sci2018; 50(3): 217–224.
25.
DuaABhardwajB.A case report on use of cog threads and dermal fillers for facial-lifting in facioscapulohumeral muscular dystrophy. J Cutan Aesthet Surg2019; 12(1): 52–55.
26.
GreenbergJ.The use of barbed sutures in obstetrics and gynecology. Rev Obstet Gynecol2010; 3(1): 82–91.
27.
SoaresCMartinsPSilvaE, et al. Cog threads for transvaginal prolapse repair: ex-vivo studies of a novel concept. Surgeries2022; 3(2): 101–110.
28.
HüschTMagerROberE, et al. Quality of life in women of non-reproductive age with transvaginal mesh repair for pelvic organ prolapse: a cohort study. Int J Surg2016; 33: 36–41.
29.
PahwaRGoyalABansalP.Chronic inflammation. Pathobiology of Human Disease: A Dynamic Encyclopedia of Disease Mechanisms 2023: 300–314.
30.
GruberDDWarnerWBLombardiniED, et al. Anatomical and histological examination of the porcine vagina and supportive structures. Female Pelvic Med Reconstr Surg2011; 17(3): 110–114.
31.
RubodCBoukerrouMBrieuM, et al. Biomechanical properties of vaginal tissue: preliminary results. Int Urogynecol J Pelvic Floor Dysfunct2008; 19(6): 811–816.
32.
Dassault Systèmes Simulia Corp. Abaqus software. Computer software. Version 2022.
33.
ArrudaEMBoyceMC.A three-dimensional constitutive model for the large stretch behavior of rubber elastic materials. J Mech Phys Solids1993; 41(2): 389–412.
34.
SilvaMETParenteMPLBrandãoS, et al. Characterization of the passive and active material parameters of the pubovisceralis muscle using an inverse numerical method. J Biomech2018; 71: 100–110.
35.
VazMFMartinsJAPPinheiroF, et al. Optimizing melt electrowriting prototypes for printing non-medical and medical grade polycaprolactone meshes in prolapse repair. J Appl Polym Sci2024; 142(4): e56408.
36.
VazMFRMartinsJAPPinheiroF, et al. Medical- and non-medical-grade polycaprolactone mesh printing for prolapse repair: Establishment of melt electrowriting prototype parameters. Appl Sci2024; 14(21): 9670.
37.
SterkSSilvaEFernandesAA. Development of new surgical mesh geometries with different mechanical properties using the design freedom of 3D printing. In: 2023 IEEE 7th Portuguese meeting on bioengineering (ENBENG), pp.144–147. IEEE.
38.
OverbeckNNagvajaraGMFerzocoS, et al. In-vivo evaluation of a reinforced ovine biologic: a comparative study to available hernia mesh repair materials. Hernia2020; 24(6): 1293–1306.
39.
MartinsJPda SilvaETFernandesAA, et al. Three-dimensional melted electrowriting drug coating fibers for the prevention of device-associated infections: a pilot study. Bioengineering2024; 11(7): 636.
40.
GülbittiHAColebundersBPirayeshA, et al. Thread-lift sutures: still in the lift a systematic review of the literature. Plast Reconstr Surg2018; 141(3): 341e–3347.
