Modern technologies in the assessment and treatment of pelvic organ prolapse - experimental and clinical studies

This project has shown that pelvic organ prolapse is linked with maternal age and delivery-related injuries. Up to every eight women may have a symptomatic prolapse already one year after their first delivery. Moreover, those with muscle injury have a higher short-term risk of pelvic organ prolapse development. To improve our knowledge we further explored the potential of an ovine model for prolapse and vaginal surgery. We showed that many anatomical and morphological features and vaginal wall changes induced by specific lifespan factors (first delivery, artificial menopause, and hormonal replacement) are similar to what is observed in women. We further used this model for testing novel implants and mesh visualization techniques. We believe that the ovine model can be used in future research on pelvic organ prolapse pathophysiology and novel treatment modalities.

The influences on the incidence of orofacial clefts in Czech Republic

Cleft lip and palate is one of the most common congenital developmental defects . Morphological character defect has severe negative functional effects on swallowing , breathing, chewing and speech formation . aesthetically , the This is a significant handicap facial triad that affects the most overall facial appearance . Approximately 15 % of children have a defect associated with other disabilities , but isolated defect is neither lethal nor associated with mental failure . It is clear that the defect is a problem both health psychological and socio-economic . Therefore , the issue of treatment of patients with cleft recognized worldwide as so important that in this respect works close international cooperation, which is also included Czech Republic . It should be emphasized that the solution to the question of facial clefts has in the Czech Republic long tradition whose beginnings are associated with on behalf of Professor František Burian and Plastic Surgery Clinic in Prague, where he is currently the Center for cleft defects . The Czech Republic has center two , one already mentioned in Prague and one in Brno

Modern technologies in the assessment and treatment of pelvic organ prolapse - experimental and clinical studies

This project has shown that pelvic organ prolapse is linked with maternal age and delivery-related injuries. Up to every eight women may have a symptomatic prolapse already one year after their first delivery. Moreover, those with muscle injury have a higher short-term risk of pelvic organ prolapse development. To improve our knowledge we further explored the potential of an ovine model for prolapse and vaginal surgery. We showed that many anatomical and morphological features and vaginal wall changes induced by specific lifespan factors (first delivery, artificial menopause, and hormonal replacement) are similar to what is observed in women. We further used this model for testing novel implants and mesh visualization techniques. We believe that the ovine model can be used in future research on pelvic organ prolapse pathophysiology and novel treatment modalities.

Moderní technologie ve vyšetřování a léčbě sestupu pánevních orgánů - experimentální a klinické studie

This project has shown that pelvic organ prolapse is linked with maternal age and delivery-related injuries. Up to every eight women may have a symptomatic prolapse already one year after their first delivery. Moreover, those with muscle injury have a higher short-term risk of pelvic organ prolapse development. To improve our knowledge we further explored the potential of an ovine model for prolapse and vaginal surgery. We showed that many anatomical and morphological features and vaginal wall changes induced by specific lifespan factors (first delivery, artificial menopause, and hormonal replacement) are similar to what is observed in women. We further used this model for testing novel implants and mesh visualization techniques. We believe that the ovine model can be used in future research on pelvic organ prolapse pathophysiology and novel treatment modalities.tTento projekt ukázal, že sestup pánevních orgánů spojen jednak s poraněními pánevního dna vzniklými v průběhu vaginálního porodu a jednak s věkem rodičky. Již jeden rok po porodu lze až u každá osmá žena identifikovat významný sestup. Ženy, které utrpěly poranění svalů pánevního dna, jsou vystaveny riziku časnějšího vzniku sestupu. Proto, abychom zlepšili naše znalosti o vývoji a chirurgické léčbě sestupu pánevních orgánů, jsme podrobněji studovali ovčí model. Identifikovali jsme anatomické a morfologické podobnosti a také popsali změny poševní stěny vyvolané specifickými životními událostmi (první porodu, uměle vytvořená menopauza či hormonální substituční terapie), které jsou podobné změnám popisovaným u žen. Ovčí model jsme dále použili pro testování nových implantátů a zobrazovacích technik. Věříme, že ovčí model je možné v budoucnosti použít pro studium patofyziologie sestupu pánevních orgánů a pro testování nových léčebných metod a postupů.Department for Mother and Child CareÚstav pro péči o matku a dítě3. lékařská fakultaThird Faculty of Medicin

Evaluating alternative materials for the treatment of stress urinary incontinence and pelvic organ prolapse -a comparison of the in vivo response to meshes of polypropylene, polyvinylidene fluoride, poly-lactic acid and polyurethane implanted in rabbits for 3 months

Serious complications can occur with the mesh implants used for stress urinary incontinence and pelvic organ prolapse surgery. We aimed to evaluate two materials, currently in clinical use and two alternative materials using a rabbit abdominal model to assess host response and biomechanical properties of the materials pre and post implantation.status: publishe

Physiologic musculofascial compliance following reinforcement with electrospun polycaprolactone-ureidopyrimidinone mesh in a rat model

ISSN:1751-6161ISSN:1878-018

Assessment of Electrospun and Ultra-lightweight Polypropylene Meshes in the Sheep Model for Vaginal Surgery

Background There is an urgent need to develop better materials to provide anatomical support to the pelvic floor without compromising its function. Objective Our aim was to assess outcomes after simulated vaginal prolapse repair in a sheep model using three different materials: (1) ultra-lightweight polypropylene (PP) non-degradable textile (Restorelle) mesh, (2) electrospun biodegradable ureidopyrimidinone-polycarbonate (UPy-PC), and (3) electrospun non-degradable polyurethane (PU) mesh in comparison with simulated native tissue repair (NTR). These implants may reduce implant-related complications and avoid vaginal function loss. Design, setting, and participants A controlled trial was performed involving 48 ewes that underwent NTR or mesh repair with PP, UPy-PC, or PU meshes (n = 12/group). Explants were examined 60 and 180 d (six per group) post-implantation. Intervention Posterior rectovaginal dissection, NTR, or mesh repair. Outcome measurements and statistical analysis Implant-related complications, vaginal contractility, compliance, and host response were assessed. Power calculation and analysis of variance testing were used to enable comparison between the four groups. Results There were no visible implant-related complications. None of the implants compromised vaginal wall contractility, and passive biomechanical properties were similar to those after NTR. Shrinkage over the surgery area was around 35% for NTR and all mesh-augmented repairs. All materials were integrated well with similar connective tissue composition, vascularization, and innervation. The inflammatory response was mild with electrospun implants, inducing both more macrophages yet with relatively more type 2 macrophages present at an early stage than the PP mesh. Conclusions Three very different materials were all well tolerated in the sheep vagina. Biomechanical findings were similar for all mesh-augmented repair and NTR. Constructs induced slightly different mid-term inflammatory profiles. Patient summary Product innovation is needed to reduce implant-related complications. We tested two novel implants, electrospun and an ultra-lightweight polypropylene textile mesh, in a physiologically relevant model for vaginal surgery. All gave encouraging outcomes.ISSN:2405-456

Finite element model focused on stress distribution in the levator ani muscle during vaginal delivery

Cílem této práce byl vývoj sofistikovaného modelu vycházejícího ze snímků MRI a následná simulace změn levatoru ani (MLA) během vaginálního porodu. Pánev ženy a hlava dítěte byly modelovány tuhými tělesy. MLA a obturátorový sval byly reprezentovány Ogdenovým materiálovým modelem. Okrajové podmínky nahradily všechna anatomická omezení a podpory. Střední hodnota napětí ve svalu MLA během průchodu hlavy byla 4.91–7.93 MPa. Největší hodnoty napětí byly nalezeny v puboviscerální a purorektální části MLA (27.46 MPa). Sval MLA byl prodloužen 2,5 krát oproti své původní klidové pozici. Obecně řešeno, oblast největšího napětí byla odhalena v části připojení ke stydké kosti. Právě tato oblast je považována za oblast největšího rizika poranění s dlouhodobými komplikacemi.The objective of this study was to develop a sophisticated MRI-based model to simulate changes in the levator ani muscle (MLA) during vaginal delivery. The female pelvis and the fetal head were modeled by rigid bodies. The MLA and obturator were represented by Ogden material model. The boundary conditions reflected all anatomical constraints and supports. The mean stress values in the MLA during fetal head passage were 4.91–7.93 MPa. The highest stress values were induced in the pubovisceral and puborectal MLA (mean 27.46 MPa). The MLA was elongated by nearly 2.5 times from its initial resting position. The absolute stress values were highest in muscle area arising from the pubic bone. This area is at the highest risk for muscle injuries with long-term complications