PECASE: Advancing Treatment of Pelvic Floor Disorders through Discoveries in Elasticity and Viscoelasticity of Uterosacral and Cardinal Ligaments

Virginia Polytechnic Institute And State University, Blacksburg VA

Investigators

Abstract

1150397 De Vita Pelvic floor disorders (PFDs) such as urinary incontinence, fecal incontinence, and pelvic organ prolapse represent a major public health concern in the United States affecting one third of adult women. These disorders are determined by structural and mechanical alterations of the pelvic organs, their supporting muscles and connective tissues that occur mainly during pregnancy, vaginal delivery, and aging. The national cost burden imposed by PFDs is alarming in terms of direct health care costs, lost productivity, and decreased quality of life. It is projected to increase dramatically by 2050 with the increase in the aging population in the United States. New research forecasts that the number of adult women affected by PFDs will increase from to 28.1 million in 2010 to 43.8 million in 2050. The alarming cost burden and projected high incidence of PFDs emphasize the critical need for research in engineering and science that leads to the development of new treatment strategies. This CAREER project aims at determining the elastic and viscoelastic properties of two major ligaments supporting the uterus and vagina: the uterosacral ligaments (USLs) and cardinal ligaments (CLs). Rigorous mechanical experiments will be performed on USLs and CLs to completely characterize their important role as supportive structures of the uterus and vagina. Mechanical testing will be then coupled with synchrotron X-ray diffraction imaging in order to reveal the collagenous micro-structure of USLs and CLs with unprecedented details. The results of the experiments will be used to develop reliable structurally-based constitutive models for USLs and CLs and assess their predictive capabilities. These models will be derived within a nonlinear integral representation theory, which encompasses the quasi-linear viscoelasticity and the modified superposition principle, and has the potential to successfully capture expected nonlinearities in the mechanical response of the USLs and CLs. Intellectual Merit. This project will potentially transform surgical reconstruction methods and post-operative rehabilitation protocols for female PFDs by offering new knowledge about the structural and mechanical properties of USLs and CLs. Currently, the USLs and CLs are either adjusted in ad-hoc manner or replaced using synthetic tapes for enhancing the suspension of the uterus and vagina. This innovative research will be crucial in establishing science-based guidelines and specific protocols for the treatment of PFDs ultimately providing better care for millions of adult women afflicted by these disorders. The PI has a unique blend of analytical skills and experimental prowess that makes her especially qualified to conduct the proposed research. The Biophysics Collaborative Access Team at the Argonne National Laboratory will provide the PI with the necessary expertise and training to use the synchrotron X-ray facilities. Through the collaboration with the Department of Obstetrics and Gynecology at the Walter Reed Army Medical Center, the PI will keep herself abreast of the challenges in female pelvic medicine and reconstructive surgery and contribute firsthand to the care and management of PFDs. Broader Impact. In this project, research and education are seamlessly integrated to enhance the students' curriculum and increase the participation of underrepresented groups in science and engineering. The education program creates new partnerships between Virginia Tech and the community in the region, increasing the leadership role of the PI's home institution in the state's societal and educational initiatives. Undergraduate and graduate students will participate in the proposed research and education components of the project. A new graduate course on nonlinear mechanics of biological systems will be developed and an undergraduate course will be significantly revised to include laboratory hours in experimental biomechanics. Interactive mini-lectures complemented with hands-on activities in biomechanics, prepared in formats understandable by non-scientists, are proposed to enrich the science curriculum at the Blacksburg Middle School and engage the visitors of the Science Museum of Western Virginia. Summer camps and mentorship will be offered to high school students with disabilities in order to facilitate their transition to college. Lunch and group meetings for women faculty in engineering will be organized to create a supportive environment and mentoring relationships. The findings of these research and education efforts will be disseminated on the web, published in peer-reviewed journals, and presented at national and international conferences.