My vagina didwhat?": Evaluating a patient mobile app of 3D enterocele anatomy in post-hysterectomy women

Objective: Despite the complicated anatomy of pelvic organ prolapse, there are few resources to educate patients about their prolapse Knowledge gaps cause patients stress and shame surrounding their condition, limiting their ability to seek medical advice Thus, supplementing counseling with effective patient education may address patient fears and improve communication between patient and provider The objectives were to: (1) develop an interactive mobile application (app) to assist health care providers in educating post-hysterectomy women on the three-dimensional (3D) anatomy of enterocele and (2) assess the educational value of the app as a visual aid during counseling Methods: Reviewed and approved by the Colorado Multiple Institutional Review Board (COMIRB Exempt #19-2347), 3D models were segmented from a de-identified CT urogram and pelvic MRI of a female diagnosed with enterocele post-hysterectomy using 3D Slicer Artifacts were smoothed and refined in ZbrushCore 2018 The models were then animated in Autodesk Maya 2019 and imported into a game engine, Unreal Engine 4, to be packaged into a mobile app The 'myProlapse' app was iteratively designed to allow manipulation of the models and to highlight relevant structures of pelvic anatomy (Figure 1) The mobile app was revised based on surveys from health care providers evaluating the app's need and usability To test the efficacy of the app, eligible patients will be randomized into two groups: (1) the Standard Counseling group, defined as routine counseling, and (2) the Mobile App group, defined as counseling supplemented by the app Patients will complete pre-and post-intervention surveys assessing anxiety and anatomical understanding Results: 53% of the health care providers (n=15) agreed the mobile app is essential for patient education in the clinic, 67% of the providers would always use the app when explaining enterocele to their patients, and 73% of the providers are very likely to recommend the app to their colleagues Patient data collection is currently halted and will resume upon effective management of COVID-19 Conclusions: Positive provider feedback suggests the 'myProlapse' app has considerable potential to assist health care providers in educating patients Traditionally, women's perspectives and issues are underrepresented in medicine By developing a mobile app to increase public awareness, we intend to normalize the conversation and overcome the social stigma of pelvic organ prolapse