Annals of Biomedical Engineering, Vol. 37, No. 7, July 2009 (Ó 2009) pp.

1425–1433
DOI: 10.1007/s10439-009-9705-2

Feasibility of Using a Computer Modeling Approach to Study SUI

Induced by Landing a Jump
YINGCHUN ZHANG,1 SEOGGWAN KIM,2 ARTHUR G. ERDMAN,2 KENNETH P. ROBERTS,1
and GERALD W. TIMM1
1
Department of Urologic Surgery, University of Minnesota, 725 Mayo Memorial Building, 420 Delaware Street S.E.,
Minneapolis, MN 55455, USA; and 2Department of Mechanical Engineering, University of Minnesota, Minneapolis, USA
(Received 20 October 2008; accepted 17 April 2009; published online 5 May 2009)

Abstract—Stress urinary incontinence (SUI) occurs due to INTRODUCTION

anatomic and/or neurologic factors involving connective
tissues, muscles and nerves. Although SUI is more common
in post-menopausal and multiparous women, studies have
also shown a high prevalence of SUI in young, physically fit
female athletes. With a goal toward dynamic subject-specific
mechanical characterization of the interaction between ana-
tomical structures during physical activities that elicit SUI in
females during physical or daily activities, a computer aided
design (CAD)-based computer model of the female pelvis has
been developed to test the feasibility of the computer
modeling approach in understanding the measurable differ-
ences between stress-continent and stress-incontinent women.
In the present study, a fluid–structure interaction analysis was
conducted by using the finite element (FE) analysis technique
based on the CAD-based computer model of the female pelvis
to investigate the urine leakage in females during jumping. To
the best of our knowledge, this is the first application of a
fluid–structure interaction FE analysis approach in
understanding the mechanisms of SUI in females. Through
a series of computer simulations, the effects of varying impact
forces determined by jumping height and bladder volume
were investigated. The dynamic computer simulation results
revealed that jumping heights have a significant influence on
the volume of urine leakage caused by the landing impact of
jumping. Bladder volume did not have a significant influence
on leakage when the jumping heights were smaller than 1 ft,
which indicates that normal walking (corresponds to a
jumping height smaller than 0.1 ft) is not the primary cause
of urine leakage for healthy females. The computer simulation
results also showed that the deformation difference between
the anterior and posterior portion of the female pelvis causes
opening of the urethra and resultant urine leakage. The
present study demonstrates the feasibility of using a computer
modeling approach to study female SUI during physical and
daily activities.
Keywords—Finite element analysis, Fluid–structure interac-
tion analysis, Female athletes, Stress urinary incontinence,
Urologic pelvic floor disorder, Physical activity.
Address correspondence to Yingchun Zhang, Department of
Urologic Surgery, University of Minnesota, 725 Mayo Memorial
Building, 420 Delaware Street S.E., Minneapolis, MN 55455, USA.
Electronic mail: zhang320@umn.edu
1425
Stress urinary incontinence (SUI) occurs because of
problems with connective tissues, muscles, and nerves
that help to hold or release urine. It currently affects
over 13 million Americans with the majority being
females. Although SUI is more common in post-men-
opausal and multiparous women,13 studies have also
shown a high prevalence of SUI in young, physically fit
female athletes.4,6,9,14,16,19,20,22 Regarding the associa-
tion of exercise type with female athletic SUI rate, it is
noted that exercises that involve chronic, repetitive
motion and involve high impact landing from jumping
and running cause high SUI rates.6,16,20,22 New data
also suggests a correlation between severity of SUI
symptoms and physical inactivity.4,18 The symptoms of
SUI that cause women to avoid sports participation
may be one etiologic factor for physical inactivity in
women.4,10,14,15 However, the mechanism of SUI in
young female athletes remains unclear.
Urodynamic studies provide a method for objectively
assessing how the bladder and urethral coordinated
functions of storing and releasing urine are operating in
order to gain a better understanding of the occurrence of
SUI and to assist with choosing an effective treatment.
The complete urodynamic study consists of cystometry
with electromyography, urethral profilometry and free
uroflowmetry using a direct measuring approach.1
These techniques, however, cannot provide the detailed
dynamic information of force, stress, strain, and
resulting organ displacements of the bladder and ure-
thra which are critical in understanding, diagnosing, and
treating SUI problems. A computer modeling approach,
which can provide us the dynamic biomechanical
responses of the bladder, urethra, rhabdosphincter, and
all the other organs and tissues inside the pelvis as well as
their neural control, has the capability of fixing this gap.
A few studies have been attempted in this
field,3,7,8,10,24,25 in which the finite element (FE) method
0090-6964/09/0700-1425/0 Ó 2009 Biomedical Engineering Society
1426 ZHANG et al.

was employed to build a pelvis model. These previous

pelvis models either did not include sufficient anatomi-
cal parts of the pelvis which are closely related to the
lower urinary tract function, or used mechanical prop-
erties of the tissues from either dated literature or animal
experimental data.
With a goal toward the development of a dynamic
subject-specific mechanical characterization the inter-
action between anatomical structures during physical
activities that elicit SUI, a computer aided design
(CAD)-based FE model of female pelvis has been
developed to understand female SUI induced by the
landing impact of jumping. CAD-based modeling of a
complex structure, such as the female pelvis, requires
some simplifying assumptions regarding its geometry.
This modeling approach, however, has an advantage
of much easier modification of the geometry and
consequently makes a feasibility and parameter study
for an advanced subject-specific computer model. This
study describes a computer modeling approach that
has the capability of characterizing the interaction FIGURE 1. Anatomical structure of the female pelvis and the
between anatomical structures during physical activi- corresponding CAD-based FE model with half of the model
about sagittal plane except urine. (a) Anatomical structure of
ties that elicit SUI. the female pelvis; (b) 3D FE model of the female pelvis which
consists of the pelvic bone, uterus, vagina, rectum, pelvic
diaphragm, uro-genital diaphragm, abdomen muscle, intes-
tine, bladder, urethra, urine etc.
MATERIALS AND METHODS
endopelvic fascia.23 These include the pubovesicle lig-
Anatomy of the Female Pelvis aments that support the bladder neck and urethra, and
the pubocervical, transverse cervical (Cardinal), and
The female pelvis is created by two innominate
ureterosacral ligaments that support the uterus. In
bones and the sacrum2,12,17 as shown in Fig. 1a. The
addition, the peritoneal broad ligament supports the
inferior aperture, or pelvic outlet, is covered by the
body of the uterus and the adnexa.
pelvic diaphragm; a set of thin broad muscles is
The female pelvic viscera include the bladder,
attached to pelvic sidewall by vascular and connective
vagina, uterus, fallopian tubes, ovaries, and rectum.
tissue mesentery.5 The muscles of the pelvic diaphragm
Each of these structures, with the exception of the
include the levator ani, a combined muscle sheet
ovaries, is composed primarily of smooth muscle. The
including the iliococcygeus, pubococcygeus, and
pelvic and UG diaphragms support these structures
puborectalis muscles, and the coccygeus muscle. Just
and participate in their function by providing striated
inferior to the pelvic diaphragm the anterior half of the
sphincter musculature.
pelvic outlet is covered by the urogenital (UG) dia-
phragm. The UG diaphragm is composed of a deep
transverse perineal muscle, spanning from one ischial CAD-Based FE Model Building Procedure
tuberosity to the other, and the external urethral
CAD-Based Geometry Model and Hexahedral Element
sphincter covered by the perineal membrane. The
Mesh
superficial transverse perineal muscle lies superior to
the perineal membrane which is directly above the deep Based on the understanding of the anatomical
transverse perineal muscle, and separates the superfi- structure of the female pelvis, a three-dimensional (3D)
cial and deep perineal compartments. Visceral struc- FE model was built using the CAD technique as shown
tures supported by the UG and pelvic diaphragms in Fig. 1b. The 3D FE model of female pelvis was built
include the uterus, the vagina, the bladder, and the to include the pelvic bone, uterus, vagina, rectum,
urethra. The rectum lies behind the UG diaphragm pelvic diaphragm, UG diaphragm, abdominal muscles,
and is supported primarily by the levator ani portion intestine, bladder, urethra, urine, etc., to model the
of the pelvic diaphragm. There are several sets of fas- actual anatomical structure of the female pelvis. For
cial ligaments that stabilize the pelvic viscera. The the ordinary static structural analyses, 3D FE model-
deepest and strongest of these are formed from the ing of structures with complex shapes can be done
 Feasibility of Using a Computer Modeling Approach to Study SUI 1427

without much simplification of the geometry using

either a solid modeler or image based solid construction
technique and tetrahedron mesh.3,7,10 Simulating the
biomechanical responses of the human body during the
landing impact of jumping requires dynamic, large
deformation analysis with large mesh distortions.
Tetrahedron elements without strong distortion resis-
tance are known to be much less accurate than hexa-
hedral elements in this case. In order to achieve the
same accuracy of analysis results, the number of tet-
rahedron elements that will be required is 4 to 5 times
more than the number of hexahedral elements. This
will increase the model size and require more com-
puting resource. In the present study, the female pelvis
model was meshed with 8-noded hexahedral elements, FIGURE 2. A Stress–Green Strain curve obtained by per-
forming soft tissue testing procedure on a bladder wall tissue
as shown in Fig. 1b, to achieve the satisfied accuracy specimen from a fresh 18-year-old female cadaver.
while keep the relative small model size (with the ele-
ment number of 325,531 and node number of 82,918). In order to refine the pelvis model, a method to
The urethra was modeled with shell elements instead characterize the visco-hyperelastic material properties
of solid elements to avoid low-quality elements. The urine of human soft tissues by performing soft tissue testing
inside the bladder was modeled using fluid elements in procedures on urological tissue specimens harvested
order to investigate urine leakage during jumping. from fresh cadavers within 24 h of the time of death
has been undertaken in our lab. Three soft tissue
Tissue Mechanical Properties testing procedures (tensile tests, creep tests, and stress
relaxation tests) were performed on urological soft
Mechanical properties of the tissues involved in this
tissue specimens to develop this urological tissue
study are listed in Table 1.7,26 Human tissues show
properties database. The completion of the database is
visco-hyperelastic material characteristics,26 however,
still in process and the computer model of the female
a quasi-linear material property was found in human
pelvis will be continuously refined by using updated
urological soft tissues from our soft tissue tensile
visco-hyperelastic material properties of urological
testing experiments when the stress level is below 70%
tissues involved in the model.
of the maximal stress value. An example of this
observation is shown in Fig. 2, which is the stress–
Contacts and Interaction Conditions
strain curve obtained by performing the soft tissue
testing procedure on a bladder wall tissue specimen Both contact pairs and tie constraints were set up in
from a fresh 18-year-old female cadaver. It was found the present pelvis model to describe the interaction
in our preliminary FE analysis results that the peak conditions along the boundaries between different
stress values developed in the tissues during jumping organs. The tie constraints were set to boundaries on
were in this quasi-linear range of the stress strain which two neighboring organ surfaces would not have
profiles. Consequently linear material models were any relative sliding and/or disconnection during
implemented in the present study to approximate the jumping. For example, the boundaries between pelvic
essential visco-hyperelastic material models. bones and pelvic muscles as well as pelvic bones and
pelvic ligaments were under this tie constraint. The
TABLE 1. Mechanical properties of the tissues involved contact pairs were set to boundaries on which two
in this study. neighboring organ surfaces would slide and/or move
apart during jumping. For example, the boundaries
Tissue Modulus of elasticity (MPa) Density (kg/m3)
between pelvic muscles and fat tissues, pelvic muscles
Bladder 0.05 1030 and pelvic ligaments, pelvic ligaments and fat tissues,
Urethra 0.3 1030 bladder and uterus, uterus and colon, etc., all were able
Uterus 0.05 1030 to slide under such contact conditions.
Vagina 0.005 1030
Rectum 0.1 1030
Intestine 0.1 1030 Load Modulus
Muscle 2.4 1040 This model assumed that the pelvic bones supported
Fascia 1.2 1010
Ligament 1.2 1010
the superincumbent body during jumping and the
entire pelvis model had an initial velocity Vinitial. Then
1428
the velocity of the bones was assumed to drop to zero
in a very short time period Timpact after the subject’s
feet touch the ground. Choices for Vinitial and Timpact,
which describe the landing impact effects on the female
pelvis and the organs inside caused by jumping, are
critical in forming the load modulus which is a neces-
sary part of the computer model.
An ambulatory device was specifically developed for
determining the real initial velocity Vinitial and impact
period Timpact for each subject. The device consists of
three sensors; the first sensor is an accelerometer
(CXL25LP3 accelerometer, Crossbow Technology,
Inc., San Jose, CA) for measuring the time-history
acceleration of pelvis in three directions in an orthog-
onal coordinate system, the second sensor is an incli-
nometer (SQ-SI2X-360DA inclinometer, SignalQuest,
Inc., Lebanon, NH) for measuring the pitch and roll
angles of pelvis, and the third sensor is a urinary
leakage detector for quantitatively measuring subjects’
urine leakage during jumping. The measurements from
the accelerometer and inclinometer directly contrib-
uted to calculating the initial velocity Vinitial and
impact period Timpact, while the measurements from
the urinary leakage detector were used to evaluate UI
during jumping.
In human subject experiments, the accelerometer
and inclinometer were fixed over the lower back at the
level of the posterior iliac crest or lumbar spine of
subject as shown in Fig. 3. All the measurements were
collected wirelessly by a PC during subject’s physical
or daily activities. The initial velocity Vinitial was esti-
mated from the temporal acceleration recordings
through the integration algorithm and the impact
period Timpact was estimated from the temporal accel-
eration recordings in the impact parameters database.
Those subject-specific landing impact parameters were
FIGURE 3. Placement of the ambulatory device including a tri-axial accelerometer, a bi-axial inclinometer and a urinary leakage
detector. (a) Frontal view; (b) back view.
ZHANG et al.
used to form the load modulus of the subject-specific
pelvis model.
Dynamic Finite Element Analysis
A commercial finite element (FE) analysis software
package LS-DYNA11 which has the capability of
fluid–structure interaction analysis was chosen for this
dynamic study. The Eulerian type of elements were
chosen as fluid elements to model the urine in which
the mesh was fixed in space and only material would
move around over the mesh to avoid large element
distortions. Consequently, there was no mesh distor-
tion and the motion of fluids, such as urine, were
adequately modeled. The interaction between the
structure and fluid, i.e. the bladder wall and the urine
inside, were detected by overlapping the solid and fluid
elements. Note that the fluid elements must cover the
entire volume of space where the solid elements reach
while they are under deformation.
A fluid like media, such as urine, was modeled as the
viscosity material with no yield strength, no shear
stiffness, and an equation of state relates the fluid
pressure to the neighboring structures. LS-DYNA
provides a viscosity material model in which the
equations of state were defined and erosion in tension
and compression was allowed. Viscosity of 0.87 9
10 3 N s, wave speed of 4.58 m/s and density of 1020
kg/m3 were used for the physical properties of urine.
RESULTS
The dynamic biomechanical responses of the entire
female pelvis and the urinary leakage information
caused by the landing impact of jumping were achieved
 Feasibility of Using a Computer Modeling Approach to Study SUI 1429

by performing dynamic FE analysis by means of

LS-DYNA based on the computer models. Considering
this is a feasibility study rather than a subject-specific
study to simulate the real biomechanical response of
the female pelvis during jumping, it was assumed in the
computer simulations that the pelvic bones supported
the superincumbent body and the pelvic bones stopped
immediately and completely as soon as the feet tou-
ched the ground. The bladder was assumed to be fully
filled with urine, and the effects of jumping heights and
bladder volumes on the amount of urinary leakage
were investigated. The results of three jumping heights
(1, 2, and 3 ft) were compared to that of a normal daily
walking height (0.1 ft) and the bladder volumes were
chosen to be 50, 100 and 200 mL.
The 1st computer simulation of a female subject
jumping from a 3-feet high table with 100 mL urine
inside her bladder was conducted and it took around
900 s of CPU time for a single run on an IBM super-
computer with 312 Power4 processors in the Minne-
sota Supercomputing Institute (MSI) at the University
of Minnesota. Dynamic computer simulation results
showed that it took approximately 7 ms for the lower
portion of the pelvis to reach its lowest vertical posi-
tion and come back to its normal position after the
pelvic bones completely stopped. Figure 4 shows the
results from this computer simulation. Figure 4a
shows the initial pelvis geometry model without any
deformation at 0.0 ms. Figure 4b shows the model
deformation caused by the jumping impact at 2.7 ms
after the pelvic bones completely stopped. Here we can
clearly see the model geometry deformation caused the
opening of the urethra and the urine was traveling into
the urethra through the urethro-vesical junction.
Figure 4c shows the model deformation 7 ms after the FIGURE 4. Deformation of the bladder and opening of the
pelvic bones completely stopped. We found that the urethra for a case of simulating a female subject jumping from
lower portion of the pelvis almost reached its lowest a 3-feet high table with 100 mL urine inside the bladder with-
out urine in the bladder. The model deformation caused ure-
point at this time instant and the model geometry thra opening at (a) 0.0 ms, (b) 2.7 ms, and (c) 7 ms, after the
deformation caused by the jumping impact is much pelvic bones completely stopped.
larger than that at 2.7 ms. The interesting phenome-
non here was that the urethra already closed at this
time instant although the bladder deformation is very 5.6 ms after the pelvic bones completely stopped, but
large. the volume of urine was already pushed into the mid-
Figure 5 shows the dynamic status of urine flow dle part of the urethra. Figure 5d shows that at 7 ms
inside of the bladder and urethra observed from the after the pelvic bones completely stopped, the urethra
computer simulation results. Figure 5a shows urine has closed, but urine has already been pushed out of
flow at 0.0 ms when the pelvic bones just completely the body and generated the urine leakage although
stopped. The bladder deformation has not yet started there was still a very small amount of residual urine in
and there was no urethra opening and urine leakage. the middle portion of the urethra.
Figure 5b shows the urine flow at 4.3 ms after the The influence of jumping heights on the amount of
pelvic bones completely stopped, where the urethra urine leakage at different levels of bladder volumes of
opened widely in the region near the bladder neck, and 50, 100, and 200 mL was investigated through a series
a remarkable amount of urine flowed into the urethra of computer simulations based on the present CAD-
from the bladder. Figure 5c shows that the urethra based female pelvis computer model. The computer
began to close in the region near the bladder neck simulation results in Fig. 6 show that the amount of
1430 ZHANG et al.

FIGURE 5. Urine flow in the case simulating a female subject jumping from a 3-feet high table with 100 mL urine inside the
bladder. The urethra opening and resulting urine flow at (a) 0.0 ms, (b) 4.3 ms, (c) 5.6 ms, and (d) 7 ms, after the pelvic bones
completely stopped.

Bladder Volume : 50ml Bladder Volume : 100ml

Bladder Volume : 200ml
100 mL, the amount of urine leakage was increased
over 30 times, from 0.002 to 0.061 mL as the jumping
0.1
height increased from 1 to 3 ft. In the case with the
0.08 bladder volume of 200 mL, the amount of urine leak-
Urine Leakage (ml)

age was increased by 50 times, from 0.002 mL to as

0.06 high as 0.1 mL as the jumping height increased from 1
to 3 ft. Even for the case with only 50 mL urine in the
0.04
bladder, an increase of urinary leakage was also
0.02
observed when the jumping height increased, the
amount of urine leakage, which increased from 0.001
0 to 0.006 mL as the jumping height increased from 1 to
0 0.5 1 1.5 2 2.5 3 3.5 3 ft, is increased by six times.
Jumping Height (ft) Similarly, the influence of the bladder volume on the
amount of urine leakage at jumping heights of 0.1, 1.0,
FIGURE 6. The influence of jumping heights on urine leak-
age at various bladder volumes. 2.0, and 3.0 ft was investigated through a series of
computer simulations based on the CAD-based female
pelvis computer model (see Fig. 7). Notice that the
urine leakage increases significantly as the jumping bladder volume did not have noticeable influence on
height increases when the bladder volume is greater the amount of urine leakage when the jumping height
than 100 mL. In the case with the bladder volume of was smaller than 1 ft. In the lowest jumping height
 Feasibility of Using a Computer Modeling Approach to Study SUI
Jump Height : 0.1feet
Jump Height : 2 feet
0.1
0.08
Urine Leakage (ml)
0.06
0.04
0.02
0 7 ms when the much larger model deformation was
0 50 100
Urine Amount inside the Bladder (ml)
FIGURE 7. The influence of bladder volume on urine leakage
at different levels of jumping heights.
level of 0.1 ft which corresponds to the jumping height
in normal walking, there was no urine leakage at all for
all three levels of bladder volumes. Even in the case
with 1 ft jumping height, the urine leakage only
increased from 0.001 to 0.002 mL as the bladder vol-
ume increased from 50 mL to as large as 200 mL.
Those results indicate that the jumping height did not
have a significant influence on the amount of urine
leakage for the jumping height cases lower than 1 ft.
However, for the cases with the jumping heights over 2
ft, the bladder volume shows significant influence on
the amount of urine leakage. In the case with a
jumping height of 2 ft, the amount of urine leakage
increased from 0.0042 to 0.0342 mL which is more
than eight times larger as the bladder volume increased
from 50 to 200 mL. In the case with a jumping height
of 3 ft, the amount of urine leakage increased from
0.006 to as large as 0.1 mL or 16 times larger, as the
bladder volume increased from 50 to 200 mL.
DISCUSSION
Dynamic computer simulation of female SUI
induced by the landing impact of jumping was suc-
cessfully conducted in the present study based on the
CAD-based female pelvis model. By using fluid–
structure interaction analysis technique, the dynamic
deformation of the bladder, urethra and other organs
inside the female pelvis as well as the induced urine
leakage caused by the landing impact of jumping were
clearly observed. To the best of our knowledge, this is
the first time that a fluid–structure interaction FE
analysis study in understanding the mechanisms of
SUI in females has been reported. The results pre-
sented here could not possibly be achieved through the
traditional urodynamic studies. One technical advan-
tage of the present study was that the urine was
1431
Jump Height : 1 foot modeled using the Eulerian type of elements in the
Jump Height : 3 feet
pelvis model with a viscosity material with no yield
strength, no shear stiffness, and an equation of state
which relates the fluid pressure to the surrounding
structures, so that the fluid–structure interaction
analysis was successfully conducted to investigate urine
leakage.
Figure 4 showed the model deformation caused a
wide opening of the urethra at 2.7 ms after the pelvic
bones completely stopped, but the urethra closed at
150 200 250 generated. Although the time values are non-physio-
logic in amplitude, this geometrical simulation study
suggests that the opening of urethra and the resulting
urine leakage might be caused by the inconsistent
deformation of regions near the bladder neck in the
female pelvis, not caused by the absolute deformation
amounts. Reviewing the dynamic information of the
biomechanical response of the pelvis during jumping,
we noticed that the posterior portion of the pelvis is
pulled up by the sacrum and ilium and supported by
the pelvic diaphragm, while the anterior portion is
supported by the pubis and ischium with the additional
support from the UG diaphragm thereby limiting the
movement of the bladder. This causes a noticeable
difference between the amount of deformation of the
back and front portions of the pelvic floor. The max-
imum displacement of the posterior pelvis is much
larger than that of the anterior pelvis, which causes
opening and slight funneling of the urethra as shown in
Fig. 5b. As the movement continues in time, the pos-
terior portion of the pelvis starts to bounce up and
closes the urethra, shown in Fig. 5c. The maximum
opening diameter of the urethra at the urethro-vesical
junction was 4.76 mm at 4.3 ms. We can conclude that
the ilium, ischium and UG diaphragm, as well as the
sacrum and pubis play a very important role in open-
ing or closing the urethra, which is directly related to
the occurrence of urine leakage. This information
strongly influenced us to include these organs in our
future subject-specific pelvis model as the necessary
parts, although, some of them are very difficult to
model because of the small size and irregularity of the
geometry.
The elastic material properties were applied in the
present CAD-based pelvis model instead of visco-
hyperelastic material properties because the visco-
hyperelastic property data of human tissues were not
available. We are performing soft tissue testing
experiments on urological tissue specimens from
fresh cadavers to develop our urological tissue
property database. We plan to model the pelvic floor
tissues with visco-hyperelastic material property data
in future pelvis models after this database is com-
pleted.
1432 ZHANG et al.

FIGURE 8. Subject-specific FE model of the female pelvis from a 20-year-old subject’s specific high resolution MR images. The
model consists of 35 anatomical parts in total including 10 pelvic muscles, 10 pelvic ligaments, 6 pelvic bones, skin, fat tissues,
bladder, urethra, uterus, vagina and colon, rectum, anus, etc.

As a feasibility study, some simplifying assumptions
were made to use a CAD-based pelvis modeling
approach to model a complex structure such as the
female pelvis. For example, the urethra was modeled as
thin layer with shell elements although the urethral
wall actually consists of four layers from lumen to
outer wall including the vascular plexus, the longitu-
dinal and circular smooth muscle and circumferential
striated muscle.21 This modeling approach, however,
has an advantage of much easier modification of the
geometry and is consequently suitable for a feasibility
and parameter study for future advanced subject-spe-
cific pelvis modeling studies.
In order to overcome this limitation to develop a
subject-specific pelvis model, female athletes with and
without SUI were recruited to participate in the study
under the University of Minnesota Institutional
Review Board (IRB) guidelines. The subject-specific
geometry models of their pelvis and the corresponding
FE meshes were reconstructed from subject-specific
high resolution contrast MR images. A generated
realistic geometry FE model of a 20-year-old female
subject’s pelvis is shown as an example in Fig. 8. The
model consists of 35 anatomical parts including 10
pelvic muscles, 10 pelvic ligaments, 6 pelvic bones,
skin, fat tissues, bladder, urethra, uterus, vagina and
colon, rectum, anus, etc. The ambulatory device was
used on the participants to characterize their specific
landing impact parameters including the acceleration
and inclination of their pelvis during jumping. Thus
the initial velocity Vinitial and impact period Timpact
were calculated from the time-history measurements to
form the subject-specific load modulus of their specific
pelvis models. The visco-hyperelastic material proper-
ties of urological tissues involved in the pelvis model
will be used to refine the model after the database is
completed. The future plan is to conduct dynamic FE
analysis based on the subject-specific pelvis model, so
that dynamic mechanical behavior of the integrated
lower urinary tract system can be correlated with the
dynamic biomechanical response of pelvis caused by
physical or daily activities, further advancing our
understanding of the mechanisms of SUI in females.
CONCLUSIONS
The present study demonstrated the feasibility of
using a computer modeling approach to study female
SUI by correlating dynamic mechanical behavior of the
integrated lower urinary tract system with the dynamic
biomechanical response of pelvis, and suggested the
computer modeling approach has the capability to
advance our understanding of the mechanisms of SUI.
ACKNOWLEDGMENTS
This work was supported by the National Science
Foundation Grant #0646818, MIMTeC (an NSF
I/UCRC), the Minnesota Medical Foundation, the
University of Minnesota Supercomputing Institute,
and the Medical Devices Center of the Institute
for Engineering in Medicine at the University of
Minnesota.
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