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We studied the effect of the mesh stiffness on urethral mobility at Valsalva maneuver, under impairment of the supporting structures (levator ani and\/or ligaments), by using a numerical model. For that purpose, we modeled a sling with \u201clower\u201d versus \u201chigher\u201d stiffness and evaluated the mobility of the bladder and urethra, that of the urethrovesical junction (the \u03b1-angle), and the force exerted at the fixation of the sling. The effect of impaired levator ani or pubourethral ligaments (PUL) alone on the organs displacement and \u03b1-angle opening was similar, showing their important role together on urethral stabilization. When the levator ani and all the ligaments were simulated as impaired, the descent of the bladder and urethra went up to 25.02\u2009mm, that of the bladder neck was 14.57\u2009mm, and the \u03b1-angle was 129.7\u2009deg, in the range of what was found in women with SUI. Both meshes allowed returning to normal positioning, although at the cost of higher force exerted by the mesh with higher stiffness (3.4\u2009N against 2.3\u2009N), which can relate to tissue erosion. This finite element analysis allowed mimicking the biomechanical response of the pelvic structures in response to changing a material property of the midurethral synthetic mesh.<\/jats:p>","DOI":"10.1115\/1.4036606","type":"journal-article","created":{"date-parts":[[2017,5,2]],"date-time":"2017-05-02T04:30:54Z","timestamp":1493699454000},"update-policy":"https:\/\/doi.org\/10.1115\/crossmarkpolicy-asme","source":"Crossref","is-referenced-by-count":13,"title":["On the Stiffness of the Mesh and Urethral Mobility: A Finite Element Analysis"],"prefix":"10.1115","volume":"139","author":[{"given":"Sofia","family":"Brand\u00e3o","sequence":"first","affiliation":[{"name":"Department of Radiology, Centro Hospitalar de S\u00e3o Jo\u00e3o\u2014EPE (CHSJ-EPE)\/Faculty of Medicine, University of Porto, Alameda Professor Hern\u00e2ni Monteiro, Porto 4200-319, Portugal;"},{"name":"Associated Laboratory for Energy, Transports and Aeronautics (LAETA), Institute of Science and Innovation in Mechanical and Industrial Engineering (INEGI), Faculty of Engineering, University of Porto, Rua Dr. Roberto Frias s\/n, Porto 4200-465, Portugal e-mail:"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marco","family":"Parente","sequence":"additional","affiliation":[{"name":"Associated Laboratory for Energy, Transports and Aeronautics (LAETA), Institute of Science and Innovation in Mechanical and Industrial Engineering (INEGI), Faculty of Engineering, University of Porto, Rua Dr. Roberto Frias s\/n, Porto 4200-465, Portugal e-mail:"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thuane Huyer","family":"Da Roza","sequence":"additional","affiliation":[{"name":"Biomechanics Laboratory, Center of Health and Sport Sciences, Santa Catarina State University (CEFID\/UDESC), Rua Paschoal Simone, 358, Bairro dos Coqueiros, Florian\u00f3polis 88080-350, Santa Catarina, Brazil;"},{"name":"Associated Laboratory for Energy, Transports and Aeronautics (LAETA), Institute of Science and Innovation in Mechanical and Industrial Engineering (INEGI), Faculty of Engineering, University of Porto, Rua Dr. Roberto Frias s\/n, Porto 4200-465, Portugal e-mail:"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elisabete","family":"Silva","sequence":"additional","affiliation":[{"name":"Associated Laboratory for Energy, Transports and Aeronautics (LAETA), Institute of Science and Innovation in Mechanical and Industrial Engineering (INEGI), Faculty of Engineering, University of Porto, Rua Dr. Roberto Frias s\/n, Porto 4200-465, Portugal e-mail:"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Isabel Maria","family":"Ramos","sequence":"additional","affiliation":[{"name":"Department of Radiology, CHSJ-EPE\/Faculty of Medicine, University of Porto, Alameda Professor Hern\u00e2ni Monteiro, Porto 4200-319, Portugal e-mail:"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Teresa","family":"Mascarenhas","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, CHSJ-EPE\/Faculty of Medicine, University of Porto, Alameda Professor Hern\u00e2ni Monteiro, Porto 4200-319, Portugal e-mail:"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Renato Manuel","family":"Natal Jorge","sequence":"additional","affiliation":[{"name":"Associated Laboratory for Energy, Transports and Aeronautics (LAETA), Institute of Science and Innovation in Mechanical and Industrial Engineering (INEGI), Faculty of Engineering, University of Porto, Rua Dr. Roberto Frias s\/n, Porto 4200-465, Portugal e-mail:"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"33","published-online":{"date-parts":[[2017,6,7]]},"reference":[{"issue":"1","key":"2019100601325697700_bib1","doi-asserted-by":"publisher","first-page":"5","DOI":"10.1007\/s00192-009-0976-9","article-title":"An International Urogynecological Association (IUGA)\/International Continence Society (ICS) Joint Report on the Terminology for Female Pelvic Floor Dysfunction","volume":"21","year":"2010","journal-title":"Int. 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