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Use of Computational Morphometry and Modeling to Assess the Impact of Aging and Prolapse Repair on Female Pelvic Anatomy

Bowen, Shaniel (2023) Use of Computational Morphometry and Modeling to Assess the Impact of Aging and Prolapse Repair on Female Pelvic Anatomy. Doctoral Dissertation, University of Pittsburgh. (Unpublished)

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By the age of 80, nearly 1 in 5 women in the U.S. will undergo pelvic reconstructive surgery for either pelvic organ prolapse (POP)—the descent of the pelvic organs into the vagina—or stress urinary incontinence (SUI)—the involuntary loss of urine with physical movement or activity. The primary goal of POP/SUI surgery is to restore and preserve normal pelvic anatomy and function, as abnormal postoperative morphology (size, shape) and position may be associated with pelvic floor dysfunction. However, there is little quantitative data on (1) what constitutes “normal” female pelvic anatomy (vagina/urethra/clitoris), especially in age- and racially diverse populations, and (2) the relationship between pelvic anatomy and pelvic floor function after POP/SUI surgery. Additionally, current clinical assessments are unable to fully characterize pelvic anatomy due to being limited to manual external vaginal examination or 2D imaging analysis. Consequently, it remains unclear whether POP/SUI surgeries reestablish and maintain normal pelvic anatomy and if there are postoperative anatomical characteristics of the pelvic organs associated with functional outcomes after POP/SUI surgery. Therefore, the purpose of this work was to use 3D image-based computational approaches to:
• Determine age-related and racial differences in normal pelvic anatomy (size/shape/position) across the adult female lifespan (Aim 1).
• Evaluate the relationship between postoperative pelvic anatomy and the following after POP/SUI surgery: surgical approach, anatomic outcome (success/failure), and patient-reported functional outcomes (Aim 2).
• Identify morphological and position differences between normal pelvic anatomy and postoperative pelvic anatomy after POP/SUI surgery (Aim 3).
Aim 1 revealed significant age and racial interaction effects and differences in normal pelvic anatomy. Aim 2 determined that the type and anatomic outcome of POP/SUI surgery influenced pelvic anatomy and that patient-reported functional outcomes significantly correlated with pelvic organ morphology and position. Aim 3 showed that regardless of the type or anatomic outcome of POP/SUI surgery, postoperative pelvic anatomy significantly differed from normal. Outcomes provide vital comprehensive data on normative and postoperative female pelvic anatomy and the latter’s relationship with patient-reported functional outcomes for surgical consideration. Findings may help elucidate potential anatomical and surgical factors/mechanisms involved in the incidence of—and disparities in—pelvic floor dysfunction.


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Item Type: University of Pittsburgh ETD
Status: Unpublished
CreatorsEmailPitt UsernameORCID
Bowen, Shanielstb103@pitt.edustb1030000-0002-4410-8481
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Committee ChairAbramowitch, Stevensdast9@pitt.edusdast9
Committee MemberLockhart,
Committee MemberMaiti, Spandanspm54@pitt.edspm54
Committee MemberMoalli,
Committee MemberSigal,
Date: 14 September 2023
Date Type: Publication
Defense Date: 11 April 2023
Approval Date: 14 September 2023
Submission Date: 16 July 2023
Access Restriction: 2 year -- Restrict access to University of Pittsburgh for a period of 2 years.
Number of Pages: 240
Institution: University of Pittsburgh
Schools and Programs: Swanson School of Engineering > Bioengineering
Degree: PhD - Doctor of Philosophy
Thesis Type: Doctoral Dissertation
Refereed: Yes
Uncontrolled Keywords: age, clitoris, computational morphometry, hysterectomy, hysteropexy, morphology, pelvic anatomy, pelvic floor, pelvic organ prolapse, position, race, sexual function, statistical shape modeling, stress urinary incontinence, surgery, urethra, vagina
Date Deposited: 14 Sep 2023 13:43
Last Modified: 14 Sep 2023 13:43


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