Investigation of interaction phenomena between lower urinary tract and artificial urinary sphincter in consideration of
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ORIGINAL PAPER
Investigation of interaction phenomena between lower urinary tract and artificial urinary sphincter in consideration of urethral tissues degeneration Arturo Nicola Natali1,2 · Emanuele Luigi Carniel1,2 · Chiara Giulia Fontanella1,2 Received: 20 December 2019 / Accepted: 2 April 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Lower urinary tract dysfunction pertains to symptoms related to the lower urinary tract (LUT), with consequent incontinence. Artificial urinary sphincters (AUS) are adopted to obtain continence conditions, mainly in male subjects, via urethral occlusion by applying pressure load, mostly operating on the basis of an empirical approach. Considering the frequent access of elderly patients to this surgical practice, tissue degradation related to aging phenomena must be investigated. Computational models of the LUT structures and the AUS systems have been designed to evaluate tissues mechanical stimulation and degenerative phenomena for reciprocal interaction. Virtual solid models of the LUT have been developed starting from biomedical images, as histological/morphometrical data. Segmentation procedures have been exploited to provide the three-dimensional reconstruction, and subsequent discretization techniques led to the finite element model. Contemporarily, a finite element model of a typical AUS device was developed. Numerical analyses have been performed to analyze interaction phenomena between AUS and LUT. Different conditions were investigated, modifying both loading conditions, as intraluminal pressure and AUS action, and urethral tissues properties. Particular attention was devoted to tissues parameters, aiming to evaluate the influence of tissues degeneration because of aging and/or pathologies. Keywords Artificial urinary sphincter · Urethral tissues mechanics · Computational model · Degenerative phenomena · Numerical analysis
1 Introduction Lower urinary tract (LUT) dysfunction (LUTD), with consequent urinary incontinence (UI), is common in both men and women, with age increasing incidence. Urinary continence results from urethral lumen closure in every life condition: at rest and during acute or prolonged abdominal pressure increase. UI is a condition that presents considerable health and social difficulties, bringing physical discomfort and economic burden (Minassian et al. 2003; Santos et al. 2017). Social problems include altered social interactions, loss of sleep and concentration, embarrassment and depression. The * Emanuele Luigi Carniel [email protected] 1
Department of Industrial Engineering, University of Padova, Via Venezia 1, 35131 Padua, Italy
Centre for Mechanics of Biological Materials, University of Padova, Padua, Italy
2
prevalence of UI symptoms grows with age at an increase rate of 5.9% between 40 to 60 years. UI leads to a miserable quality of life, with huge costs and still sub-optimal solutions by artificial urinary sphincters (AUS) (Cordon et al. 2016; Chung 2014; Hampel et al. 2010; Irwin et al. 2
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