Pelvic organ prolapse (POP) afflicts from 13.1 to 25.9% of women in China and the U.S. so severely that it requires surgery in ~230,000 American women per year, with a 25% surgical failure rate even in best hands. The successful, complication-free, treatment of this problem is one of the biggest challenges facing urogynecologists today. Considering the aging population, this would become not only a medical issue but a social problem as well. The pathomechanism of pelvic organ prolapse is complex and involves multiple structures. The lack of the ability to identify the specific structure failure sites in the complex muscular and connective tissue apparatus leading to her prolapse also limits our ability to understand operative failure and hinders the effective surgical planning and treatment innovation. Recently, UM investigators have for the first time developed cutting-edge techniques combining “3D Stress MRI” with biomechanical structural analyses to identify failure mechanisms —ushering in a new era of pelvic floor science. Shifting from empirical treatment management to treatment based on biomechanics-informed precision medicine and surgical planning could greatly advance the field of the prolapse surgery just as significantly as the introduction of echocardiography changed of treatment congestive heart failure. This will benefit all the women and their descendants in the U.S. and nationwide population in China.

• To date, a total of 67 subjects from both sides were enrolled. A protocol has been established between Michigan Medicine and PKUHSC to transfer and share de-identified MRI data. 
• The newly acquired high-resolution MRI allows the detailed study of Level III anatomical structures and their connections. For example, perineal membrane as a key structure in Level III support can now be reconstructed as 3D model based on living women's anatomy. We developed the measurement scheme allows structure hypothesis being tested. This work has been selected as Best Clinical/Non-Surgical Abstract and will be presented in Joint Scientific Meeting 2019, entitled "MR- Based Perineal Membrane Quantification in Nulliparous and Parous Women With and Without Prolapse: Technique Development".
• We developed the technique to reconstruct Level III Pelvic Floor "Connectome" and demonstrate our ability to reconstruct these structures in both women with and without injury/prolapse. This work has been submitted to international conference (AUGS/IUGA 2019) and has been selected as long podium presentation, titled as "The Level III Pelvic Floor "Connectome": Technique development and proof of concept "accepted as long podium presentation" and Preliminary Findings".