Finite element analysis of vaginal tape at different positions for the treatment of arcus tendineus fascia pelvis damage-induced stress urinary incontinence

Abstract

Background

The purpose of this study was to use the finite element analysis method to simulate sling surgeries for arcus tendineus fascia pelvis damage-induced stress urinary incontinence: tension-free vaginal tape and tension-free vaginal tape - obturator, to evaluate their therapeutic effects at different positions of the urethra, and to judge the occurrence of complications through the sling-urethra interaction force which is difficult to obtain clinically.

Methods

Pelvic geometric model was constructed based on the MRI of a woman without pelvic floor diseases. The constraints between arcus tendineus fascia pelvis and the lateral wall of the vagina were removed to simulate arcus tendineus fascia pelvis rupture. Gradient abdominal pressure was applied to the incontinence model, and tension-free vaginal tape and tension-free vaginal tape - obturator were placed at the proximal (30 %), mid-distal (60 %), and distal ends (80 %) of the urethra, respectively.

Findings

All three types of slings were able to return the parameters of the urethra and bladder to normal levels. High urethral pressure was observed with proximal placement. Distal placement led to a “knot” effect and sudden pressure spikes as abdominal pressure increased. Mid-distal placement resulted in the lowest urethral pressure. The pressure between tension-free vaginal tape and the urethra was generally greater than that between tension-free vaginal tape - obturator.

Interpretation

Placing slings at various positions within the urethra can all treat arcus tendineus fascia pelvis damage-induced stress urinary incontinence; the mid-distal tension-free vaginal tape - obturator should be considered the preferred treatment option.