On the Stiffness of the Mesh and Urethral Mobility: A Finite Element Analysis.

Midurethral slings are used to correct urethral hypermobility in female stress urinary incontinence (SUI), defined as the complaint of involuntary urine leakage when the intra-abdominal pressure (IAP) is increased. Structural and thermal features influence their mechanical properties, which may explain postoperative complications, e.g., erosion and urethral obstruction. We studied the effect of the mesh stiffness on urethral mobility at Valsalva maneuver, under impairment of the supporting structures (levator ani and/or ligaments), by using a numerical model. For that purpose, we modeled a sling with "lower" versus "higher" stiffness and evaluated the mobility of the bladder and urethra, that of the urethrovesical junction (the α-angle), and the force exerted at the fixation of the sling. The effect of impaired levator ani or pubourethral ligaments (PUL) alone on the organs displacement and α-angle opening was similar, showing their important role together on urethral stabilization. When the levator ani and all the ligaments were simulated as impaired, the descent of the bladder and urethra went up to 25.02 mm, that of the bladder neck was 14.57 mm, and the α-angle was 129.7 deg, in the range of what was found in women with SUI. Both meshes allowed returning to normal positioning, although at the cost of higher force exerted by the mesh with higher stiffness (3.4 N against 2.3 N), which can relate to tissue erosion. This finite element analysis allowed mimicking the biomechanical response of the pelvic structures in response to changing a material property of the midurethral synthetic mesh.

Modeling the contraction of the pelvic floor muscles.

We performed numerical simulation of voluntary contraction of the pelvic floor muscles to evaluate the resulting displacements of the organs and muscles. Structures were segmented in Magnetic Resonance (MR) images. Different material properties and constitutive models were attributed. The Finite Element Method was applied, and displacements were compared with dynamic MRI findings. Numerical simulation showed muscle magnitude displacement ranging from 0 to 7.9 mm, more evident in the posterior area. Accordingly, the anorectum moved more than the uterus and bladder. Dynamic MRI showed less 0.2 mm and 4.1 mm muscle dislocation in the anterior and cranial directions, respectively. Applications of this model include evaluating muscle impairment, subject-specific mesh implant planning, or effectiveness of rehabilitation.

Morphologic differences in the vocal tract resonance cavities of voice professionals: an MRI-based study.

UNLABELLED: The processes that take place during singing and acting are complex. However, morphologic and dynamic studies of the vocal tracts during speech have been gaining greater attention, mainly because of the rapid technical advances being made with magnetic resonance imaging (MRI) and image analysis and processing techniques. OBJECTIVES/HYPOTHESIS AND METHODS: Our aim was to describe the morphologic differences in the vocal tract resonance cavities among voice professionals using MRI, and with the three-dimensional models built from the MRI data, compare the volumes calculated for the whole vocal tract and its major resonance cavities. STUDY DESIGN: Prospective study. RESULTS: The images acquired during the spoken and singing tasks provided morphologic information about the whole vocal tract cavity and also its two major resonance cavities: the oral and the pharynx cavities; differences were observed in the volumes measured during the production of some vowels. CONCLUSIONS: The morphologic differences found in the singing voices indicated an increase in the oral cavity volume, resulting in an increase in the overall volumes measured. In the acting voices, both the resonance cavities of the vocal tract contributed to the differences measured.