Medical Student Research Fellowship for Summer 2012

Mentor:                       Dr. Philippe Zimmern          
Department:               Urology          
Room number:           J08.122         
Mail Code:                 9110              
Phone number:          214-648-9397          
E-mail:                        philippe.zimmern@utsouthwestern.edu                
Project title:                Relevance of a newly designed cutometer-like probe for routine vaginal examination in the outpatient setting.          

Human subjects IRB approved project number (where applicable):      

Animal subjects IRB approved project number (where applicable):      

Project Type: Patient-based research

Brief Description of Project: 

Background:

• Pelvic organ prolapse (POP) affects a large number of aging women, often necessitates surgical repair, and tends to recur over time. 
• Evaluation of the vaginal wall is limited to physical examination and imaging modalities. There are no quantitative and practical devices to measure the unique visco-elastic properties of the vagina to objectively determine tissue deterioration. 
• For the past 10 years, we have studied vaginal wall properties in fresh excised tissue at the time of surgery using an Instron tensile testing machine.  Although novel, fruitful and exciting, this line of research is limited by its applicability, namely patients requiring surgery. 
• Then, over the past 4 years, following research done on wound healing in plastic surgery, we studied the use of the BTC-2000™ cutometer-like device in women operated for POP.  However, the size and configuration of this probe was severely limited to measures of vaginal changes in advanced prolapse that had herniated down to the opening or even out of the vagina.  The inability to study controls, less advanced degrees of POP, or patients before and after surgical repair or hormonal therapy, for example, led to a research effort to design a vaginal probe more suited for all individuals.
• Over this past year, the existing probe was re-designed to be small enough to be inserted in the vagina, yet measure precisely the tissue deflection and recovery under mild suction and vacuum release.  This newly designed probe has been tested against the older probe and shown to have good intra- and inter-tester reliability in the operating room in patients under anesthesia.

 
Study Design:
This proposal is to study this new vaginal version of the BTC-2000 in the office setting in patients scheduled for POP repair vaginally.
Caitlin will introduce the new device to patients and obtain measurements using the device.  She will collect data on ease of use, patient acceptability (questionnaire), and accuracy and reproducibility of the biomechanical parameters extracted from the collected data (laxity, elasticity, elastic deformation, and Young’s modulus). Additionally, she will compare the data collected in the office setting to data obtained in the operating room under anesthesia, and with follow-up data obtained after surgery.

Relevance:
Such a device would, for the first time, allow a direct in-vivo measurement of vaginal wall tissue properties. This could influence a myriad of common vaginal interventions, from pelvic floor therapy to reconstructive surgery.  Like the thermometer to determine how sick a patient is, this device would serve as a fantastic resource for clinicians and researchers interested in the management of POP, an embarrassing and costly affliction which greatly affects the quality of life of millions of women.

Previous Research Activities or Publications with Medical Students:

Mosier E, Lin VK, Zimmern P. Extracellular matrix expression of human prolapsed vaginal wall. Neurourol Urodyn. 29(4):582-586, 2010.

Murray S, Schlomer BJ, Jerome R, Zimmern PE:  Secondary autologous fasica slings fare            more poorly than primary slings.

Mosier E, Jerome R, Xie X-J, Chuong C, Yan J, Eberhart R, Zimmern P:  In vivo      (Cutometer©) measurement of anterior vaginal wall biomechanical properties in        prolapse patients undergoing surgical repair.  Submitted to Neurourology and     Urodynamics.

Mosier E, Haverkorn RM, Zimmern PE. Abstract #1538: 3-D ultrasound assessment of     collagen volume stability and durability over time in incontinent women.  AUA Annual    Meeting, April 24 ¨C 28, 2009, Chicago, Illinois

Chuong C, Towns R, Eberhart R, Mosier E, Zimmern P. Development of a biomechanical finite element model to predict prolapsed anterior vaginal wall compartment             properties.  Podium presentation ICS meeting 8/22-27/2010, Toronto.

Adam N. Romman, Feras Alhalabi, and Philippe E. Zimmern.  Urethral dilation under        anesthesia in women

Jerome R, Murray S, Zimmern P;  The dark side of prophylactic suburethral tape    placement.  Poster, SUFU Annual meeting, St. Petersburg, Florida. 2010.

Schomer B, Jerome R, Murray S, Haverkorn R, Zimmern P.  Secondary autologous fascia slings fare more poorly than primary slings.  Poster. SUFU Annual meeting, St.   Petersburg, Florida, 2010.

Mosier E, Jerome R, Chuong C, Eberhart R, Zimmern P. In vivo measurement of the          anterior vaginal wall biomechanical properties in prolapse patients undergoing             surgical repair. Podium presentation, SUFU Annual meeting, St. Petersburg, Florida,   2010.