Documente Academic
Documente Profesional
Documente Cultură
1425–1433
DOI: 10.1007/s10439-009-9705-2
the velocity of the bones was assumed to drop to zero used to form the load modulus of the subject-specific
in a very short time period Timpact after the subject’s pelvis model.
feet touch the ground. Choices for Vinitial and Timpact,
which describe the landing impact effects on the female
Dynamic Finite Element Analysis
pelvis and the organs inside caused by jumping, are
critical in forming the load modulus which is a neces- A commercial finite element (FE) analysis software
sary part of the computer model. package LS-DYNA11 which has the capability of
An ambulatory device was specifically developed for fluid–structure interaction analysis was chosen for this
determining the real initial velocity Vinitial and impact dynamic study. The Eulerian type of elements were
period Timpact for each subject. The device consists of chosen as fluid elements to model the urine in which
three sensors; the first sensor is an accelerometer the mesh was fixed in space and only material would
(CXL25LP3 accelerometer, Crossbow Technology, move around over the mesh to avoid large element
Inc., San Jose, CA) for measuring the time-history distortions. Consequently, there was no mesh distor-
acceleration of pelvis in three directions in an orthog- tion and the motion of fluids, such as urine, were
onal coordinate system, the second sensor is an incli- adequately modeled. The interaction between the
nometer (SQ-SI2X-360DA inclinometer, SignalQuest, structure and fluid, i.e. the bladder wall and the urine
Inc., Lebanon, NH) for measuring the pitch and roll inside, were detected by overlapping the solid and fluid
angles of pelvis, and the third sensor is a urinary elements. Note that the fluid elements must cover the
leakage detector for quantitatively measuring subjects’ entire volume of space where the solid elements reach
urine leakage during jumping. The measurements from while they are under deformation.
the accelerometer and inclinometer directly contrib- A fluid like media, such as urine, was modeled as the
uted to calculating the initial velocity Vinitial and viscosity material with no yield strength, no shear
impact period Timpact, while the measurements from stiffness, and an equation of state relates the fluid
the urinary leakage detector were used to evaluate UI pressure to the neighboring structures. LS-DYNA
during jumping. provides a viscosity material model in which the
In human subject experiments, the accelerometer equations of state were defined and erosion in tension
and inclinometer were fixed over the lower back at the and compression was allowed. Viscosity of 0.87 9
level of the posterior iliac crest or lumbar spine of 10 3 N s, wave speed of 4.58 m/s and density of 1020
subject as shown in Fig. 3. All the measurements were kg/m3 were used for the physical properties of urine.
collected wirelessly by a PC during subject’s physical
or daily activities. The initial velocity Vinitial was esti-
mated from the temporal acceleration recordings RESULTS
through the integration algorithm and the impact
period Timpact was estimated from the temporal accel- The dynamic biomechanical responses of the entire
eration recordings in the impact parameters database. female pelvis and the urinary leakage information
Those subject-specific landing impact parameters were caused by the landing impact of jumping were achieved
FIGURE 3. Placement of the ambulatory device including a tri-axial accelerometer, a bi-axial inclinometer and a urinary leakage
detector. (a) Frontal view; (b) back view.
Feasibility of Using a Computer Modeling Approach to Study SUI 1429
FIGURE 5. Urine flow in the case simulating a female subject jumping from a 3-feet high table with 100 mL urine inside the
bladder. The urethra opening and resulting urine flow at (a) 0.0 ms, (b) 4.3 ms, (c) 5.6 ms, and (d) 7 ms, after the pelvic bones
completely stopped.
Jump Height : 0.1feet Jump Height : 1 foot modeled using the Eulerian type of elements in the
Jump Height : 2 feet Jump Height : 3 feet
pelvis model with a viscosity material with no yield
0.1
strength, no shear stiffness, and an equation of state
0.08
which relates the fluid pressure to the surrounding
Urine Leakage (ml)
FIGURE 8. Subject-specific FE model of the female pelvis from a 20-year-old subject’s specific high resolution MR images. The
model consists of 35 anatomical parts in total including 10 pelvic muscles, 10 pelvic ligaments, 6 pelvic bones, skin, fat tissues,
bladder, urethra, uterus, vagina and colon, rectum, anus, etc.
As a feasibility study, some simplifying assumptions completed. The future plan is to conduct dynamic FE
were made to use a CAD-based pelvis modeling analysis based on the subject-specific pelvis model, so
approach to model a complex structure such as the that dynamic mechanical behavior of the integrated
female pelvis. For example, the urethra was modeled as lower urinary tract system can be correlated with the
thin layer with shell elements although the urethral dynamic biomechanical response of pelvis caused by
wall actually consists of four layers from lumen to physical or daily activities, further advancing our
outer wall including the vascular plexus, the longitu- understanding of the mechanisms of SUI in females.
dinal and circular smooth muscle and circumferential
striated muscle.21 This modeling approach, however,
has an advantage of much easier modification of the CONCLUSIONS
geometry and is consequently suitable for a feasibility
The present study demonstrated the feasibility of
and parameter study for future advanced subject-spe-
using a computer modeling approach to study female
cific pelvis modeling studies.
SUI by correlating dynamic mechanical behavior of the
In order to overcome this limitation to develop a
integrated lower urinary tract system with the dynamic
subject-specific pelvis model, female athletes with and
biomechanical response of pelvis, and suggested the
without SUI were recruited to participate in the study
computer modeling approach has the capability to
under the University of Minnesota Institutional
advance our understanding of the mechanisms of SUI.
Review Board (IRB) guidelines. The subject-specific
geometry models of their pelvis and the corresponding
FE meshes were reconstructed from subject-specific
high resolution contrast MR images. A generated
ACKNOWLEDGMENTS
realistic geometry FE model of a 20-year-old female
subject’s pelvis is shown as an example in Fig. 8. The This work was supported by the National Science
model consists of 35 anatomical parts including 10 Foundation Grant #0646818, MIMTeC (an NSF
pelvic muscles, 10 pelvic ligaments, 6 pelvic bones, I/UCRC), the Minnesota Medical Foundation, the
skin, fat tissues, bladder, urethra, uterus, vagina and University of Minnesota Supercomputing Institute,
colon, rectum, anus, etc. The ambulatory device was and the Medical Devices Center of the Institute
used on the participants to characterize their specific for Engineering in Medicine at the University of
landing impact parameters including the acceleration Minnesota.
and inclination of their pelvis during jumping. Thus
the initial velocity Vinitial and impact period Timpact
were calculated from the time-history measurements to
form the subject-specific load modulus of their specific REFERENCES
pelvis models. The visco-hyperelastic material proper-
1
ties of urological tissues involved in the pelvis model Abrams, P., J. G. Blaivas, S. L. Stanton, and J. T.
will be used to refine the model after the database is Andersen. The standardization of terminology of low
Feasibility of Using a Computer Modeling Approach to Study SUI 1433
14
urinary tract function recommended by the International Nygaard, I., J. O. L. DeLancey, L. Arnsdorf, and
Continence Society. Int. Urogynecol. J. 1:45–58, 1990. E. Murphy. Exercise and incontinence. Obstet. Gynecol.
doi:10.1007/BF00373608. 75:848–851, 1990.
2 15
Agur, A. M. R., and A. F. Dalley. Grant’s Atlas of Nygaard, I., T. Girts, N. H. Fultz, K. Kinchen, G. Pohl,
Anatomy. Philadelphia: Lippincott Williams and Wilkins, and B. Sternfeld. Is urinary incontinence a barrier to
2005. exercise in women. Obstet. Gynecol. 106(2):307–314, 2005.
3 16
Anderson, A. E., C. L. Peters, B. D. Tuttle, and J. A. Nygaard, I. E., F. L. Thompson, S. L. Svengalis, and J. P.
Weiss. Subject-specific finite element model of the pelvis: Albright. Urinary incontinence in elite nulliparous athletes.
development, validation and sensitivity studies. Trans. Obstet. Gynecol. 84:183–187, 1994.
17
ASME J. Biomech. Eng. 127:364–373, 2005. Platzer, W., and H. Monsen. Pernkopf Anatomy, Atlas of
4
Bø, K., R. Hagen, B. Kvarstein, and S. Larsen. Female Topographic and Applied Human Anatomy. Urban and
stress urinary incontinence and participation in different Schwarzenberg, 1989.
18
sport and social activities. Scand. J. Sports Sci. 11(3):117– Salvatore, S., M. Serati, R. M. S. Laterza, S. Uccella,
127, 1989. M. Torella, and P. Bolis. The impact of urinary stress
5
DeLancey, J. O. L. Structural support of the urethra as it incontinence in young and middle-age women practicing
relates to stress urinary incontinence: the hammock recreational sport activity: an epidemiological study. Br. J.
hypothesis. Am. J. Obstet. Gynecol. 170:1713–1720, 1994. Sports Med. 2008. doi:10.1136/bjsm.2008.049072.
6 19
Eliasson, K., T. Larsson, and E. Mattson. Prevalence of Sherman, R. A., G. D. Davis, and M. F. Wong. Behavioral
stress incontinence in nulliparous elite trampolinists. treatment of exercise-induced urinary incontinence among
Scand. J. Med. Sci. Sports 12:106–110, 2002. doi:10.1034/ female soldiers. Mil. Med. 162(10):690–694, 1997.
20
j.1600-0838.2002.120207.x. Steiger, M. M., G. W. Timm, and A. G. Erdman. Lower
7
Haridas, B., H. Hong, R. Minoguchi, S. Owens, and urinary tract symptoms and incontinence in collegiate elite
T. Osborn. PelvicSim—A computational-experimental female athletes and age matched controls. Int. Urogyn. J.,
system for biomechanical evaluation of female pelvic floor in press.
21
organ disorders and associated minimally invasive inter- Strohbehn, K., and J. O. L. DeLancey. The anatomy of
ventions. In: Medicine Meets Virtual Reality, vol. 14, pp. stress incontinence. Oper. Tech. Gynecol. Surg. 2:5–16,
182–187, 2006. 1997.
8 22
Hubener, U., and R. Van Mastrigt. Computer simulations Thyssen, H. H., L. Clevin, S. Olesen, and G. Lose. Urinary
of micturition. Urodinamica 4:81–90, 1994. incontinence in elite female athletes and dancers. Int.
9
Hunskaar, S., E. P. Arnold, K. Burgio, A. C. Diokno, Urogynecol. J. Pelvic Floor Dysfunct. 13:15–17, 2002.
A. P. Herzog, and V. T. Mallett. Epidemiology and natural doi:10.1007/s001920200003.
23
history of urinary incontinence. Int. Urogynecol. J. Pelvic Tunn, R., J. O. L. DeLancey, and E. E. Quint. Visibility of
Floor Dysfunct. 11:301–319, 2000. doi:10.1007/s0019200 pelvic organ support system structures in magnetic reso-
70021. nance images without an endovaginal coil. Am. J. Obstet.
10
Lien, K. C., B. Mooney, J. O. L. DeLancey, and J. A. Gynecol. 184(6):1156–1163, 2001. doi:10.1067/mob.2001.
Ashton-Miller. Levator ani muscle stretch induced by 112972.
24
simulated vaginal birth. Obstet. Gynecol. 103(1):31–40, Van Duin, F., P. F. W. M. Rosier, B. L. H. Bemelmans,
2004. F. M. J. Debruyne, and H. Wijkstra. A computer model for
11
LS-DYNA. A program for nonlinear dynamic analysis of describing the effect of urethral afferents on simulated
structures in three dimensions. Livermore Software Tech- lower urinary tract function. Arch. Physiol. Biochem.
nology Corporation, 2005. 107(3):223–235, 1999. doi:10.1076/apab.107.3.223.4333.
12 25
Netter, F. H. Atlas of Human Anatomy. ICON Learning Van Duyl, W. A. Urodynamics of the lower urinary tract.
Systems LLC, 2003. In: Biomechanical Modeling and Simulation on a PC: A
13
Nygaard, I., M. D. Barber, K. L. Burgio, K. Kenton, Workbench for Physiology and Biomedical Engineering,
S. Meikle, J. Schaffer, C. Spino, W. E. Whitehead, J. Wu, edited by R. P. Van Wijk van Brievingh and D. P. F.
and D. J. Brody. Prevalence of symptomatic pelvic floor Moeller. New York: Springer-Verlag, 1993.
26
disorders in US women. J. Am. Med. Assoc. 300(11):1311– Yamada, H. Strength of Biological Materials. Baltimore:
1316, 2008. doi:10.1001/jama.300.11.1311. Williams & Wilkins, 1970.
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.