{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T19:18:40Z","timestamp":1793215120026,"version":"4.5.0"},"reference-count":29,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,10,8]],"date-time":"2025-10-08T00:00:00Z","timestamp":1759881600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The traditional treatment of pelvic floor organ prolapse (POP) is based on static anatomical repair, but the postoperative recurrence rate is still high in the surgical rate, which suggests the need to re-examine its pathogenesis from a biomechanical perspective.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To propose a new concept of POP prevention and treatment centered on the dynamic mechanical balance system of the levator plate-perineum and posterior vaginal vault, and to provide a theoretical basis for clinical intervention.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>This study reveals the key mechanisms of the pelvic floor dynamic balance system through biomechanical analysis. The stability of the pelvic floor is maintained by three synergistic aspects: first, the triangular support structure composed of the bladder-uterus-tibial plate realizes effective stress transmission; second, the posterior fornix of the vagina serves as a mechanical fulcrum, guiding the uterus to produce the characteristic \u201cdownward-backward\u201d displacement; and lastly, the 90\u00b0 functional folding angle of the vagina ensures the reasonable distribution of the loads. When this sophisticated system becomes unbalanced due to birth injury or aging, it leads to abnormal stress transmission and organ displacement, ultimately leading to prolapse symptoms.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Shifting from static repair to dynamic mechanical balance reconstruction is the key to improving POP efficacy, and individualized mechanical repair strategies and long-term maintenance mechanisms need to be further explored in the future.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2025.1637133","type":"journal-article","created":{"date-parts":[[2025,10,8]],"date-time":"2025-10-08T16:51:51Z","timestamp":1759942311000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":6,"title":["Dynamic biomechanical equilibrium in pelvic organ prolapse: from mechanistic insights to precision reconstruction"],"prefix":"10.3389","volume":"12","author":[{"given":"Daoming","family":"Tian","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qian","family":"Luo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xingqi","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yubin","family":"Wen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuan","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiangna","family":"Gu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hongcheng","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jihong","family":"Shen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ling","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,10,8]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"e084034","DOI":"10.1136\/bmjopen-2024-084034","article-title":"Determinants of women's preferences for surgical versus conservative management for pelvic organ prolapse: a survey-based study from Italy","volume":"14","author":"Ferrari","year":"2024","journal-title":"BMJ Open"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"192","DOI":"10.1016\/j.ajog.2022.04.046","article-title":"Risk factors for primary pelvic organ prolapse and prolapse recurrence: an updated systematic review and meta-analysis","volume":"227","author":"Schulten","year":"2022","journal-title":"Am J Obstet Gynecol"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"107","DOI":"10.12809\/hkmj219271","article-title":"Surgical treatment of pelvic organ prolapse in women aged \u226575 years in Hong Kong: a multicentre retrospective study","volume":"28","author":"Wong","year":"2022","journal-title":"Hong Kong Med J"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"2016","DOI":"10.1001\/jama.2013.4919","article-title":"Long-term outcomes following abdominal sacrocolpopexy for pelvic organ prolapse","volume":"309","author":"Nygaard","year":"2013","journal-title":"JAMA"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"441","DOI":"10.1007\/s00192-023-05708-w","article-title":"Functional anatomy of urogenital hiatus closure: the perineal complex triad hypothesis","volume":"35","author":"DeLancey","year":"2024","journal-title":"Int Urogynecol J"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"1940005","DOI":"10.1142\/S0219519419500295","article-title":"Finite element analysis of urinary bladder wall thickness at different pressure condition","volume":"19","author":"Kent","year":"2019","journal-title":"J Mech Med Biol"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"1311","DOI":"10.1002\/nau.25194","article-title":"Bladder neck funneling in stress incontinence is mediated by posterior muscle forces, not abdominal pressure","volume":"42","author":"Petros","year":"2023","journal-title":"Neurourol Urodyn"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"23980","DOI":"10.1038\/s41598-024-75014-y","article-title":"Clinical value of transperineal ultrasound in evaluating the effects of different delivery methods on the primipara pelvic floor structure and function","volume":"14","author":"Cai","year":"2024","journal-title":"Sci Rep"},{"key":"ref9","volume-title":"Computer-simulated biomechanical research based on magnetic resonance imaging of female pelvic organ prolapse [dissertation]","author":"Li","year":"2022"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"3021","DOI":"10.20944\/preprints202309.0853.v1","article-title":"Osteology of the Hamadryas baboon (Papio hamadryas)","volume":"13","author":"Casteleyn","year":"2023","journal-title":"Animals"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"45","DOI":"10.4103\/0971-3026.113625","article-title":"Does conventional defecography has a role to play in evaluation of evacuatory disorders in Indian population?","volume":"23","author":"Kumar","year":"2013","journal-title":"Indian J Radiol Imaging"},{"key":"ref12","first-page":"352","article-title":"Development of the urogenital system","volume-title":"Gray\u2019s Anatomy: The Anatomical Basis of Clinical Practice","author":"Standring","year":"2021"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"1501","DOI":"10.1067\/mob.2002.130005","article-title":"Morphometric properties of the posterior vaginal wall in women with pelvic organ prolapse","volume":"187","author":"Boreham","year":"2002","journal-title":"Am J Obstet Gynecol"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"2309","DOI":"10.2147\/RMHP.S268235","article-title":"The role of obstetric factors, miRNA-30d and miRNA-181a in postpartum women with pelvic organ prolapse","volume":"13","author":"Lin","year":"2020","journal-title":"Risk Manag Healthc Policy"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"735","DOI":"10.3969\/j.issn.1009-8291.2023.09.001","article-title":"Biomechanical mechanisms and treatment strategies of female bladder prolapse [in Chinese]","volume":"28","author":"Shen","year":"2023","journal-title":"J Mod Urol"},{"key":"ref16","volume-title":"Study on levator ani muscle function in women during different pregnancy periods by transperineal pelvic floor ultrasound [dissertation]","author":"Tan","year":"2023"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"1930","DOI":"10.1080\/10255842.2022.2159759","article-title":"A 3D finite element model of uterus support to evaluate mechanisms underlying uterine prolapse formation","volume":"26","author":"Chen","year":"2023","journal-title":"Comput Methods Biomech Biomed Engin"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"456","DOI":"10.1186\/s12884-020-03070-z","article-title":"A protocol for developing, disseminating, and implementing a core outcome set (COS) for childbirth pelvic floor trauma research","volume":"20","author":"Doumouchtsis","year":"2020","journal-title":"BMC Pregnancy Childbirth"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"505","DOI":"10.1007\/s00404-016-4023-z","article-title":"MRI changes of pelvic floor and pubic bone observed in primiparous women after childbirth by normal vaginal delivery","volume":"294","author":"Shi","year":"2016","journal-title":"Arch Gynecol Obstet"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"123456","DOI":"10.3389\/fbioe.2023.1292407","article-title":"The influence of the combined impairments and apical mesh surgery on the biomechanical behavior of the pelvic floor system","volume":"11","author":"Xue","year":"2024","journal-title":"Front Bioeng Biotechnol"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"1316","DOI":"10.1002\/nau.24963","article-title":"Surgical anatomy of the vaginal vault","volume":"41","author":"Haylen","year":"2022","journal-title":"Neurourol Urodyn"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"410","DOI":"10.31486\/toj.19.0089","article-title":"Pelvic organ prolapse: a review of in vitro testing of pelvic support mechanisms","volume":"20","author":"Conway","year":"2020","journal-title":"Ochsner J"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"427","DOI":"10.1016\/j.ajog.2019.10.006","article-title":"From molecular to macro: the key role of the apical ligaments in uterovaginal support","volume":"222","author":"Kieserman-Shmokler","year":"2019","journal-title":"Am J Obstet Gynecol"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"455","DOI":"10.1093\/ptj\/pzx019","article-title":"Recent advances in understanding pelvic-floor tissue of women with and without pelvic organ prolapse: considerations for physical therapists","volume":"97","author":"Saunders","year":"2017","journal-title":"Phys Ther"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"1580","DOI":"10.1016\/j.jbiomech.2015.02.041","article-title":"A multi-compartment 3-D finite element model of rectocele and its interaction with cystocele","volume":"48","author":"Luo","year":"2015","journal-title":"J Biomech"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"757","DOI":"10.1016\/j.urology.2013.06.036","article-title":"Long-term outcomes following abdominal sacrocolpopexy for pelvic organ prolapse","volume":"82","author":"Elterman","year":"2013","journal-title":"Urology"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"760723","DOI":"10.3389\/fsurg.2022.760723","article-title":"Comparison of the axes and positions of the uterus and vagina between women with and without pelvic floor organ prolapse","volume":"9","author":"Li","year":"2022","journal-title":"Front Surg"},{"key":"ref28","doi-asserted-by":"publisher","DOI":"10.1007\/s00192-025-06153-7","article-title":"Urogenital hiatus closure: facts, fallacies, and why a unified theory of hiatal failure is needed","author":"DeLancey","year":"2025","journal-title":"Int Urogynecol J"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"CD016148","DOI":"10.1002\/14651858.CD016148","article-title":"Perineal techniques during the second stage of labour for reducing perineal trauma and postpartum complications","volume":"10","author":"Dwan","year":"2024","journal-title":"Cochrane Database Syst Rev"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2025.1637133\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,8]],"date-time":"2025-10-08T16:51:53Z","timestamp":1759942313000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2025.1637133\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,8]]},"references-count":29,"alternative-id":["10.3389\/fmed.2025.1637133"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2025.1637133","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,8]]},"article-number":"1637133"}}