1
|
Verhorstert KW, Riool M, Bulten T, Guler Z, de Boer L, Roovers JPW, Zaat SA. The impact of bacterial contamination on the host response towards fully absorbable poly-4-hydroxybutyrate and nonabsorbable polypropylene pelvic floor implants. Mater Today Bio 2022; 15:100268. [PMID: 35517580 PMCID: PMC9062440 DOI: 10.1016/j.mtbio.2022.100268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 04/11/2022] [Accepted: 04/17/2022] [Indexed: 11/03/2022] Open
Abstract
Polypropylene (PP) implants for the vaginal surgical correction of pelvic organ prolapse (POP) are known for adverse events, like vaginal or visceral exposures. It is hypothesized that this is a result of a prolonged inflammatory response. One of the triggering factors of prolonged inflammation might be bacterial contamination. A possible solution might lie in an absorbable biomaterial, which provides initial mechanical support while being gradually replaced by the host tissue. With this study we aimed to compare the host response, in a subcutaneous mouse implant infection model, to delayed absorbable poly-4-hydroxybutyrate (P4HB) and a latest generation PP implant. By comparing non-infected to Staphylococcus aureus infected mice, we assessed how bacterial contamination affects the host response and its role in the development of complications. Further, we included sham surgery as a control, mimicking the wound response in native tissue repair. Despite the higher surface area of the P4HB implants, the clearance of infection was similarly delayed in the presence of a P4HB or PP implant, as compared to sham. Further, the host response towards P4HB and PP was quite comparable, yet collagen deposition was significantly increased around infected P4HB implants at early time points. Adverse event rates were similar, though implant exposures were only seen in infected mice and more often with PP (11.1%) than P4HB implants (5.6%). Infected mice overall had significantly higher levels of infiltration of inflammatory cells and lower levels of vascularization and collagen deposition compared to non-infected mice. Thus, for both P4HB and PP, bacterial contamination negatively affected mesh integration by increased inflammation and an increased adverse event rate. Altogether, our results from this subcutaneous mouse implant infection study suggest that P4HB could be a promising degradable alternative to PP, warranting further research to study its potential as a new surgical solution for women with POP. Absorbable poly-4-hydroxybutyrate (P4HB) is studied as a novel pelvic floor implant. Comparable host response to P4HB and polypropylene in a subcutaneous mouse implant infection model. Implant exposures exclusively occurred upon Staphylococcus aureus infection. Exposures occurred less with P4HB (5.6%) compared to polypropylene (11.1%). S. aureus infection increased inflammation and deranged the host response.
Collapse
|
2
|
Peró M, Casani L, Castells-Sala C, Pérez ML, Moga Naranjo E, Juan-Babot O, Alserawan De Lamo L, López-Chicón P, Vilarrodona Serrat A, Badimon L, Porta Roda O. Rabbit as an animal model for the study of biological grafts in pelvic floor dysfunctions. Sci Rep 2021; 11:10545. [PMID: 34006889 PMCID: PMC8131625 DOI: 10.1038/s41598-021-89698-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 04/22/2021] [Indexed: 11/28/2022] Open
Abstract
The aims of this study were to evaluate the feasibility of the New Zealand White (NZW) rabbit for studying implanted biomaterials in pelvic reconstructive surgery; and to compare the occurrence of graft-related complications of a commercial polypropylene (PP) mesh and new developed human dermal matrix implanted at vaginal and abdominal level. 20 white female NZW rabbits were randomized into two groups, experimental group (human acellular dermal matrices-hADM-graft) and control group (commercial PP graft). In each animal, grafts were surgically implanted subcutaneously in the abdominal wall and in the vaginal submucosa layer for 180 days. The graft segments were then removed and the surgical and clinical results were analyzed. The main surgical challenges during graft implantation were: (a) an adequate vaginal exposure while maintaining the integrity of the vaginal mucosa layer; (b) to keep aseptic conditions; (c) to locate and dissect the breast vein abdominal surgery; and (d) to withdraw blood samples from the ear artery. The most abnormal findings during the explant surgery were found in the PP group (33% of vaginal mesh extrusion) in comparison with the hADM group (0% of vaginal graft extrusion), p = 0.015. Interestingly, macroscopic observation showed that the integration of the vaginal grafts was more common in the hADM group (40%) than in the PP group, in which the vaginal mesh was identified in 100% of the animals (p = 0.014). The NZW rabbit is a good model for assessing materials to be used as grafts for pelvic reconstructive surgery and vaginal surgery. Animals are easily managed during the procedures, including surgical intervention and vaginal mucosa approach. Additionally, hADM is associated with fewer clinical complications, as well as better macroscopic tissue integration, compared to PP mesh.
Collapse
Affiliation(s)
- Marta Peró
- Department of Obstetrics and Gynecology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Carrer Sant Quintí, 89, 08041, Barcelona, Spain.
| | - Laura Casani
- Research Institute of the Hospital de Sant Pau-IIB Sant Pau, Barcelona, Spain
| | - Cristina Castells-Sala
- Barcelona Tissue Bank, Banc de Sang i Teixits (BST), Barcelona, Spain.,Biomedical Research Institute (IIB-Sant Pau; SGR1113), Barcelona, Spain
| | - Maria Luisa Pérez
- Barcelona Tissue Bank, Banc de Sang i Teixits (BST), Barcelona, Spain.,Biomedical Research Institute (IIB-Sant Pau; SGR1113), Barcelona, Spain
| | - Esther Moga Naranjo
- Department of Immunology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Oriol Juan-Babot
- Research Institute of the Hospital de Sant Pau-IIB Sant Pau, Barcelona, Spain
| | - Leticia Alserawan De Lamo
- Department of Immunology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Patricia López-Chicón
- Barcelona Tissue Bank, Banc de Sang i Teixits (BST), Barcelona, Spain.,Biomedical Research Institute (IIB-Sant Pau; SGR1113), Barcelona, Spain
| | - Anna Vilarrodona Serrat
- Barcelona Tissue Bank, Banc de Sang i Teixits (BST), Barcelona, Spain.,Biomedical Research Institute (IIB-Sant Pau; SGR1113), Barcelona, Spain
| | - Lina Badimon
- Research Institute of the Hospital de Sant Pau-IIB Sant Pau, Barcelona, Spain
| | - Oriol Porta Roda
- Department of Obstetrics and Gynecology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Carrer Sant Quintí, 89, 08041, Barcelona, Spain
| |
Collapse
|
3
|
Verhorstert KWJ, Gudde AN, Kortz BS, Limpens J, Roovers JWR, Hooijmans CR, Guler Z. Animal experimental research assessing urogynecologic surgical mesh implants: Outcome measures describing the host response, a systematic review and meta-analysis. Neurourol Urodyn 2021; 40:1107-1119. [PMID: 33951222 PMCID: PMC8359983 DOI: 10.1002/nau.24677] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 02/17/2021] [Accepted: 04/05/2021] [Indexed: 12/27/2022]
Abstract
Aim Before the introduction of new biomaterials for prolapse surgery, animal studies on the host response are required. Unfortunately, large variation in study design hampers obtaining an overview of the safety and efficacy, and translation to clinical practice. Our aim is to systematically review the literature on all outcome measures describing the host response in animal studies assessing the biocompatibility of urogynecologic surgical mesh implants for prolapse surgery. Furthermore, by meta‐analysis, we aim to assess the effect of implantation and compare this to control animals receiving sham surgery or native tissue repair. Methods We performed a systematic search from inception to August 2020. Since this is an explorative study we included original, controlled, and noncontrolled animal studies describing any host response to the implant. Quantitative outcome measures reported ≥10 times in ≥2 articles were eligible for meta‐analysis. Results Fifty articles were included in the qualitative synthesis and 36 articles were eligible for meta‐analysis. In total, 154 outcome measures were defined and classified into (1) histomorphology, (2) biomechanics and, (3) macroscopic morphology. Animals with vaginal implants demonstrated significantly increased M1 and M2 macrophages, MMP‐2, neovascularization, TNF‐α, and stiffness, and lower vaginal contractility compared to control animals. Conclusion The host response significantly differs in animals after vaginal mesh implantation compared to control animals, both pro‐ and anti‐inflammatory. However, we observed a paucity in the uniformity of reported outcomes. For future animal studies, we propose the development of a core outcome set, which ideally predicts the host response in women.
Collapse
Affiliation(s)
- Kim W. J. Verhorstert
- Department of Obstetrics and Gynecology, Amsterdam Reproduction and Development, Amsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
| | - Aksel N. Gudde
- Department of Obstetrics and Gynecology, Amsterdam Reproduction and Development, Amsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
| | - Brita S. Kortz
- Department of Obstetrics and Gynecology, Amsterdam Reproduction and Development, Amsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
| | - Jacqueline Limpens
- Medical Library, Amsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
| | - Jan‐Paul W. R. Roovers
- Department of Obstetrics and Gynecology, Amsterdam Reproduction and Development, Amsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
| | - Carlijn R. Hooijmans
- Department for Health Evidence unit SYRCLERadboud University Medical CenterNijmegenThe Netherlands
| | - Zeliha Guler
- Department of Obstetrics and Gynecology, Amsterdam Reproduction and Development, Amsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
| |
Collapse
|
4
|
Mackova K, Mazzer AM, Mori Da Cunha M, Hajkova Hympanova L, Urbankova I, Kastelein AW, Vodegel E, Vander Linden K, Fehervary H, Guler Z, Roovers JP, Krofta L, Verhaeghe J, Deprest J. Vaginal Er:YAG laser application in the menopausal ewe model: a randomised estrogen and sham-controlled trial. BJOG 2020; 128:1087-1096. [PMID: 33017509 DOI: 10.1111/1471-0528.16558] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2020] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To describe effects of non-ablative erbium-doped:yttrium-aluminium-garnet (Er:YAG) laser on vaginal atrophy induced by iatrogenic menopause in the ewe. DESIGN Animal experimental, randomised, sham and estrogen-treatment controlled study with blinding for primary outcome. SETTING KU Leuven, Belgium. SAMPLE Twenty-four ewes. METHODS Menopause was surgically induced, after which the ewes were randomised to three groups receiving vaginal Er:YAG laser application three times, with a 1-month interval; three sham manipulations with a 1-month interval; or estrogen replacement and sham manipulations. At given intervals, ewes were clinically examined and vaginal wall biopsies were taken. Vaginal compliance was determined by passive biomechanical testing from explants taken at autopsy. MAIN OUTCOME MEASURES Vaginal epithelial thickness (primary), composition of the lamina propria (collagen, elastin, glycogen and vessel content), vaginal compliance, clinical signs. RESULTS Animals exposed to Er:YAG laser application and sham manipulation, but not to estrogens, displayed a significant and comparable increase in vaginal epithelial thickness between baseline and 7 days after the third application (69% and 67%, respectively, both P < 0.0008). In laser-treated ewes, temporary vaginal discharge and limited thermal injury were observed. Estrogen-substituted ewes displayed a more prominent increase in epithelial thickness (202%; P < 0.0001) and higher vaginal compliance (P < 0.05). None of the interventions induced changes in the lamina propria. CONCLUSIONS Vaginal Er:YAG laser has comparable effect to sham manipulation in menopausal ewes. TWEETABLE ABSTRACT Vaginal Er:YAG laser has comparable effect to sham manipulation in menopausal ewes #LASER #GSM #RCT.
Collapse
Affiliation(s)
- K Mackova
- Department of Development and Regeneration, Cluster Urogenital, Abdominal and Plastic Surgery, KU Leuven, Leuven, Belgium.,Third Faculty of Medicine, Institute for the Care of Mother and Child, Charles University, Prague, Czech Republic
| | - A M Mazzer
- Department of Obstetrics and Gynaecology, San Raffaele University, Milan, Italy
| | - Mgmc Mori Da Cunha
- Department of Development and Regeneration, Cluster Urogenital, Abdominal and Plastic Surgery, KU Leuven, Leuven, Belgium
| | - L Hajkova Hympanova
- Department of Development and Regeneration, Cluster Urogenital, Abdominal and Plastic Surgery, KU Leuven, Leuven, Belgium.,Third Faculty of Medicine, Institute for the Care of Mother and Child, Charles University, Prague, Czech Republic
| | - I Urbankova
- Third Faculty of Medicine, Institute for the Care of Mother and Child, Charles University, Prague, Czech Republic
| | - A W Kastelein
- Department of Obstetrics and Gynaecology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - E Vodegel
- Department of Obstetrics and Gynaecology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - K Vander Linden
- Department of Mechanical Engineering, KU Leuven, Leuven, Belgium
| | - H Fehervary
- Department of Mechanical Engineering, KU Leuven, Leuven, Belgium
| | - Z Guler
- Department of Obstetrics and Gynaecology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - J P Roovers
- Department of Obstetrics and Gynaecology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - L Krofta
- Third Faculty of Medicine, Institute for the Care of Mother and Child, Charles University, Prague, Czech Republic
| | - J Verhaeghe
- Department of Development and Regeneration, Cluster Urogenital, Abdominal and Plastic Surgery, KU Leuven, Leuven, Belgium.,Pelvic Floor Unit, University Hospitals KU Leuven, Leuven, Belgium
| | - J Deprest
- Department of Development and Regeneration, Cluster Urogenital, Abdominal and Plastic Surgery, KU Leuven, Leuven, Belgium.,Pelvic Floor Unit, University Hospitals KU Leuven, Leuven, Belgium
| |
Collapse
|
5
|
The importance of developing relevant animal models to assess existing and new materials. Curr Opin Urol 2020; 29:400-406. [PMID: 31008781 DOI: 10.1097/mou.0000000000000625] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE OF REVIEW We summarize the recent literature on the use of different animal models for testing existing and new materials for treatment of pelvic organ prolapse. RECENT FINDINGS A wide spectrum of animal models is being used in urogynecology, both for the study of physiologic and pathophysiologic processes, training in surgical procedures, yet mainly to study the host response to implant materials. The quality of studies is variable, and procedures, read-outs, and reporting are not standardized. This makes comparison very difficult. The research community is experimenting with different knitting patterns, novel polymers, bioactivation, as well as resorbable rather than durable implants. Outcomes of the experiments are dependent on the location of implantation. Lighter polypropylene constructs seem to induce a less vigorous host response than elder heavier products. Modification of the surface yields contradictory findings. Resorbable acellular collagen matrices may be reintroduced as prophylactically inserted support structures. SUMMARY Although animal experimentation with novel candidate implants is advocated, there is a lack of standardization in reporting. The concept of resorbable construct is being revived, as durable materials have caused clinical graft-related complications. Large animal experiments seem to provide interesting and more comprehensive information, yet their use may be contested.
Collapse
|
6
|
Martín-Martínez A, Müller-Arteaga C, Blasco-Hernández P, Padilla-Fernández B, Martínez-García R, Errando-Smet C, Vicente-Palacio E, Cruz F, Castro-Díaz D, López-Fando L, Ros-Cerro C, Arlandis-Guzmán S, Espuña-Pons M. Position of Ibero-American Society of Neurourology and UroGynecology (SINUG) on the use of vaginal meshes in pelvic organ prolapse. Neurourol Urodyn 2020; 39:1020-1025. [PMID: 32068303 DOI: 10.1002/nau.24309] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Accepted: 01/27/2020] [Indexed: 11/10/2022]
Abstract
AIMS Pelvic organ prolapse (POP) is a very prevalent condition with a great impact on women's quality of life. At present, there is great controversy regarding the use of mesh in POP surgery. To understand the current moment, it is advisable to make a brief summary of the historical evolution of mesh use for pelvic floor pathology. The aim of this paper is to establish the position of the Ibero-American Society of Neurourology and UroGynecology (SINUG for its acronym in Spanish) regarding vaginal mesh reconstructive surgery. METHODS A working committee from the SINUG's scientific board performed a literature search about the use of vaginal meshes for pelvic organ prolapse reconstructive surgery and about the position of different societies. We analyzed the evolution into three periods: before the Food and Drug Administration (FDA) statement, FDA statement, and after the statement. SINUG drew up a position statement regarding vaginal mesh reconstructive surgery, based on the available scientific evidence and the evolution of its use in different contexts. RESULTS Before mesh appearance in the 1990s, native tissue repair was the surgical treatment of choice for POP. Vaginal mesh reconstructive surgery has been frequently accompanied by procedure underestimation by inexperienced surgeons, besides inadequate diagnoses and indications. This situation led to the presentation of serious complications including mesh extrusion, exposure, and contraction. CONCLUSIONS Once reviewed the available evidence and the position of different societies, SINUG presents its vision in this communication, which is a summary of the document prepared by the society's scientific board.
Collapse
Affiliation(s)
- Alicia Martín-Martínez
- Pelvic Floor Section, Gynecology and Obstetrics Service, Hospital Materno-Infantil de Canarias, Las Palmas de Gran Canaria, Spain
| | - Carlos Müller-Arteaga
- Reconstructive and Functional Urology Section, Urology Service, University Hospital Ourense, Ourense, Spain
| | | | - Bárbara Padilla-Fernández
- Functional Urology Section, Urology Service, Hospital Universitario de Canarias, Universidad de La Laguna, Tenerife, Spain
| | | | - Carlos Errando-Smet
- Female and Functional Urology Section, Urology Service, Fundació Puigvert, Barcelona, Spain
| | - Eduardo Vicente-Palacio
- Functional Urology Section, Urology Service, Corporación Sanitaria Parc Taulí, Sabadell, Spain
| | - Francisco Cruz
- Department of Urology, Sao Joao Hospital, Porto, Portugal
| | - David Castro-Díaz
- Functional Urology Section, Urology Service, Hospital Universitario de Canarias, Universidad de La Laguna, Tenerife, Spain
| | - Luis López-Fando
- Functional and Reconstructive Urology Section, Urology Service, Hospital Ramón y Cajal, Madrid, Spain
| | - Cristina Ros-Cerro
- Ginecological Echography Section, ICGON, Clinic Hospital, Barcelona, Spain
| | | | | |
Collapse
|
7
|
Hympánová L, Rynkevic R, Román S, Mori da Cunha MG, Mazza E, Zündel M, Urbánková I, Gallego MR, Vange J, Callewaert G, Chapple C, MacNeil S, Deprest J. Assessment of Electrospun and Ultra-lightweight Polypropylene Meshes in the Sheep Model for Vaginal Surgery. Eur Urol Focus 2020; 6:190-198. [DOI: 10.1016/j.euf.2018.07.024] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 06/21/2018] [Accepted: 07/16/2018] [Indexed: 10/28/2022]
|
8
|
G.Doucède, Morch A, Pouseele B, Lecomte-Grosbras P, Brieu M, Cosson M, Rubod C. Evolution of the mechanical properties of a medical device regarding implantation time. Eur J Obstet Gynecol Reprod Biol 2019; 242:139-143. [DOI: 10.1016/j.ejogrb.2019.08.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 08/12/2019] [Accepted: 08/27/2019] [Indexed: 11/27/2022]
|
9
|
Comparison of retropubic midurethral slings in the treatment of female stress urinary incontinence. Int Urogynecol J 2019; 31:711-716. [PMID: 31410521 DOI: 10.1007/s00192-019-04080-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 07/31/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Over 50 different types of midurethral slings have been marketed. They have generally been considered comparable in performance. Many studies have compared retropubic with obturator slings, but few have compared different makes of retropubic slings with each other. We have compared the performance of retropubic slings using data from the Norwegian Female Incontinence Registry. METHODS From June 2015 through 2017, 2843 women underwent a retropubic sling procedure, with 6-12-month follow-up data available for 2612 (92%). Results for six different types of slings used in this time period are presented: TVT Exact, TVT Classic, Advantage, Advantage Fit, TVT A.M.I. and RetroArc. The TVT Exact was the most prevalent sling, and the outcomes were compared with this sling as reference using chi-square and Dunnet's tests with significance at 0.05. RESULTS There were only small differences among the four slings, TVT Exact, TVT Classic, Advantage and Advantage Fit, with subjective cure rates from 77.7 to 81.9% and objective cure rates from 90.8 to 96.6%. The TVT A.M.I. sling had a high cure rate but significantly fewer satisfied patients and less improvement in urgency bother. The Retro Arc's results were clearly inferior. There was little difference in terms of obstruction or de novo urgency incontinence among the six slings. Most complication rates were not statistically different. CONCLUSIONS At 6-12-month follow-up there was no significant difference in clinical results between the TVT Exact, TVT Classic, Advantage and Advantage Fit slings, while RetroArc and to some extent TVT A.M.I. slings underperformed.
Collapse
|
10
|
Surgical Treatment of Female Stress Urinary Incontinence: Do Tapes Stand the Test of Time? Eur Urol 2017; 72:592-593. [PMID: 28528813 DOI: 10.1016/j.eururo.2017.05.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 05/05/2017] [Indexed: 11/24/2022]
|
11
|
Zimmern PE. Editorial Commentary. UROLOGY PRACTICE 2017; 4:244. [PMID: 37592697 DOI: 10.1016/j.urpr.2016.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
12
|
Chapple CR, Cruz F, Deffieux X, Milani AL, Arlandis S, Artibani W, Bauer RM, Burkhard F, Cardozo L, Castro-Diaz D, Cornu JN, Deprest J, Gunnemann A, Gyhagen M, Heesakkers J, Koelbl H, MacNeil S, Naumann G, Roovers JPWR, Salvatore S, Sievert KD, Tarcan T, Van der Aa F, Montorsi F, Wirth M, Abdel-Fattah M. Consensus Statement of the European Urology Association and the European Urogynaecological Association on the Use of Implanted Materials for Treating Pelvic Organ Prolapse and Stress Urinary Incontinence. Eur Urol 2017; 72:424-431. [PMID: 28413126 DOI: 10.1016/j.eururo.2017.03.048] [Citation(s) in RCA: 125] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 03/30/2017] [Indexed: 01/30/2023]
Abstract
CONTEXT Surgical nonautologous meshes have been used for several decades to repair abdominal wall herniae. Implantable materials have been adopted for the treatment of female and male stress urinary incontinence (SUI) and female pelvic organ prolapse (POP). OBJECTIVE A consensus review of existing data based on published meta-analyses and reviews. EVIDENCE ACQUISITION This document summarises the deliberations of a consensus group meeting convened by the European Association of Urology (EAU) and the European Urogynecological Association, to explore the current evidence relating to the use of polypropylene (PP) materials used for the treatment of SUI and POP, with reference to the 2016 EAU guidelines (European Association of Urology 2016), the European Commission's SCENIHR report on the use of surgical meshes (SCENIHR 2015), other available high-quality evidence, guidelines, and national recommendations. EVIDENCE SYNTHESIS Current data suggest that the use of nonautologous durable materials in surgery has well-established benefits but significant risks, which are specific to the condition and location they are used for. Various graft-related complications have been described-such as infection, chronic pain including dyspareunia, exposure in the vagina, shrinkage, erosion into other organs of xenografts, synthetic PP tapes (used in SUI), and meshes (used in POP)-which differ from the complications seen with abdominal herniae. CONCLUSIONS When considering surgery for SUI, it is essential to evaluate the available options, which may include synthetic midurethral slings (MUSs) using PP tapes, bulking agents, colposuspension, and autologous sling surgery. The use of synthetic MUSs for surgical treatment of SUI in both male and female patients has good efficacy and acceptable morbidity. Synthetic mesh for POP should be used only in complex cases with recurrent prolapse in the same compartment and restricted to those surgeons with appropriate training who are working in multidisciplinary referral centres. PATIENT SUMMARY Synthetic slings can be safely used in the surgical treatment of stress incontinence in both male and female patients. Patients need to be aware of the alternative therapy and potential risks and complications of this therapy. Synthetic mesh for treating prolapse should be used only in complex cases with recurrent prolapse in specialist referral centres.
Collapse
Affiliation(s)
| | - Francisco Cruz
- Department of Urology, Hospital São João/Faculty of Medicine of Porto, Porto, Portugal; I3S Institute for Health, Porto, Portugal
| | - Xavier Deffieux
- Department of Gynaecologic Surgery, Antoine Béclère Hospital, Paris South University, Clamart, France
| | - Alfredo L Milani
- Department of Obstetrics & Gynaecology, Reinier de Graaf Hospital, Delft, The Netherlands
| | - Salvador Arlandis
- Department of Urology, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Walter Artibani
- Department of Urology, Azienda Ospedaliero Universitaria di Verona, Verona, Italy
| | - Ricarda M Bauer
- Department of Urology, Ludwig-Maximilians-University Muenchen, Klinikum Großhadern, Muenchen, Germany
| | - Fiona Burkhard
- Department of Urology, University Hospital Bern, Bern, Switzerland
| | - Linda Cardozo
- Department of Urogynaecology, King's College Hospital, London, United Kingdom
| | - David Castro-Diaz
- Department of Urology, Hospital Universitario de Canarias, Universidad de La Laguna, Tenerife, Canary Islands, Spain
| | - Jean Nicolas Cornu
- Department of Urology, Rouen University Hospital and University of Rouen, Rouen Cedex, France
| | - Jan Deprest
- Department of Obstetrics and Gynaecology, University Hospitals Leuven, Leuven, Belgium
| | - Alfons Gunnemann
- Klinikum Lippe Urologische Klinik, Akademisches Lehrkrankenhaus der Georg-August-Universität Göttingen, Germany
| | - Maria Gyhagen
- Department of Obstetrics and Gynecology, Södra Älvsborgs Hospital, Borås, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden
| | | | - Heinz Koelbl
- Department of General Gynaecology and Gynaecologic Oncology, Medical University of Vienna, Vienna, Austria
| | - Sheila MacNeil
- Department of Tissue Engineering, University of Sheffield, Sheffield, United Kingdom
| | - Gert Naumann
- Department of Obstetrics and Gynaecology, Helios-Klinikum, Erfurt, Germany
| | - Jan-Paul W R Roovers
- Department of Obstetrics and Gynaecology, Academic Medical Center Amsterdam, University of Amsterdam, Amsterdam, The Netherlands
| | - Stefano Salvatore
- Obstetrics and Gynaecology Unit, Vita-Salute San Raffaele University, IRCCS San Raffaele Hospital, Milan, Italy
| | | | - Tufan Tarcan
- Department of Urology, Marmara University School of Medicine, Istanbul, Turkey
| | - Frank Van der Aa
- Department of Urology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Francesco Montorsi
- Department of Urology, Vita Salute San Raffaele University, Milan, Italy
| | - Manfred Wirth
- Department of Urology, University Hospital Carl Gustav Carus, Technical University of Dresden, Dresden, Germany
| | - Mohamed Abdel-Fattah
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Scotland, United Kingdom
| |
Collapse
|
13
|
Jangö H, Gräs S, Christensen L, Lose G. Examinations of a new long-term degradable electrospun polycaprolactone scaffold in three rat abdominal wall models. J Biomater Appl 2017; 31:1077-1086. [DOI: 10.1177/0885328216687664] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Alternative approaches to reinforce native tissue in reconstructive surgery for pelvic organ prolapse are warranted. Tissue engineering combines the use of a scaffold with the regenerative potential of stem cells and is a promising new concept in urogynecology. Our objective was to evaluate whether a newly developed long-term degradable polycaprolactone scaffold could provide biomechanical reinforcement and function as a scaffold for autologous muscle fiber fragments. We performed a study with three different rat abdominal wall models where the scaffold with or without muscle fiber fragments was placed (1) subcutaneously (minimal load), (2) in a partial defect (partial load), and (3) in a full-thickness defect (heavy load). After 8 weeks, no animals had developed hernia, and the scaffold provided biomechanical reinforcement, even in the models where it was subjected to heavy load. The scaffold was not yet degraded but showed increased thickness in all groups. Histologically, we found a massive foreign body response with numerous large giant cells intermingled with the fibers of the scaffold. Cells from added muscle fiber fragments could not be traced by PKH26 fluorescence or desmin staining. Taken together, the long-term degradable polycaprolactone scaffold provided biomechanical reinforcement by inducing a marked foreign-body response and attracting numerous inflammatory cells to form a strong neo-tissue construct. However, cells from the muscle fiber fragments did not survive in this milieu. Properties of the new neo-tissue construct must be evaluated at the time of full degradation of the scaffold before its possible clinical value in pelvic organ prolapse surgery can be evaluated.
Collapse
Affiliation(s)
- Hanna Jangö
- Department of Obstetrics & Gynaecology, Herlev University Hospital, Herlev Denmark
| | - Søren Gräs
- Department of Obstetrics & Gynaecology, Herlev University Hospital, Herlev Denmark
| | - Lise Christensen
- Department of Pathology, Herlev University Hospital, Herlev, Denmark
| | - Gunnar Lose
- Department of Obstetrics & Gynaecology, Herlev University Hospital, Herlev Denmark
| |
Collapse
|
14
|
Reasonable people disagree: lessons learned from the sling and mesh story. Int Urogynecol J 2016; 27:1289-91. [PMID: 27412530 DOI: 10.1007/s00192-016-3082-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2016] [Accepted: 06/11/2016] [Indexed: 10/21/2022]
|
15
|
Darzi S, Urbankova I, Su K, White J, Lo C, Alexander D, Werkmeister JA, Gargett CE, Deprest J. Tissue response to collagen containing polypropylene meshes in an ovine vaginal repair model. Acta Biomater 2016; 39:114-123. [PMID: 27163402 DOI: 10.1016/j.actbio.2016.05.010] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 04/27/2016] [Accepted: 05/03/2016] [Indexed: 12/28/2022]
Abstract
UNLABELLED Pelvic Organ Prolapse (POP) is the herniation of pelvic organs into the vagina. Despite broad acceptance of mesh use in POP surgical repair, the complication rate is unacceptable. We hypothesized that collagen-containing polypropylene (PP) mesh types could modulate mesh-tissue integration and reduce long-term inflammation, thereby reducing mesh-associated complications. This study compared the long-term tissue response to an unmodified PP mesh and two collagen containing meshes in an ovine model which has similar pelvic anatomy and vaginal size to human. Three commercially available macroporous PP meshes, uncoated PP mesh (Avaulta Solo) (PP), the same textile PP mesh layered with a sheet of cross-linked porcine acellular matrix (Avaulta Plus) (PP-ACM) and a different yet also macroporous PP (Sofradim) mesh coated with solubilized atelocollagen (Ugytex) (PP-sCOL) were implanted in the ovine vagina and tissue explanted after 60 and 180days. The macrophage phenotype and response to implanted meshes, and vascularity were quantified by immunostaining and morphometry. We quantified changes in extracellular matrix composition biochemically and collagen organisation and percentage area around the interface of the mesh implants by Sirius Red birefringence and morphometry. PP-ACM induced a more sustained inflammatory response, indicated by similar CD45(+) leukocytes but reduced CD163(+) M2 macrophages at 60days (P<0.05). PP-sCOL increased Von Willebrand Factor (vWF)-immunoreactive vessel profiles after 60days. At the micro-molecular level, collagen birefringence quantification revealed significantly fewer mature collagen fibrils (red, thick fibrils) at the mesh-tissue interface than control tissue for all mesh types (P<0.001) but still significantly greater than the proportion of immature (green thin fibrils) at 60days (P<0.05). The proportion of mature collagen fibrils increased with time around the mesh filaments, particularly those containing collagen. The total collagen percent area at the mesh interface was greatest around the PP-ACM mesh at 60days (P<0.05). By 180days the total mature and immature collagen fibres at the interface of the mesh filaments resembled that of native tissue. In particular, these results suggest that both meshes containing collagen evoke different types of tissue responses at different times during the healing response yet both ultimately lead to physiological tissue formation approaching that of normal tissue. STATEMENT OF SIGNIFICANCE Pelvic organ prolapse (POP) is the descent of the pelvic organs to the vagina. POP affects more than 25% of all women and the lifetime risk of undergoing POP surgery is 19%. Although synthetic polypropylene (PP) meshes have improved the outcome of the surgical treatment for POP, there was an unacceptable rate of adverse events including mesh exposure and contracture. It is hypothesized that coating the PP meshes with collagen would provide a protective effect by preventing severe mesh adhesions to the wound, resulting in a better controlled initial inflammatory response, and diminished risk of exposure. In this study we assessed the effect of two collagen-containing PP meshes on the long-term vaginal tissue response using new techniques to quantify these tissue responses.
Collapse
Affiliation(s)
- Saeedeh Darzi
- Hudson Institute of Medical Research, 27-31 Wright Street, Clayton, Victoria 3168, Australia; Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria 3168, Australia
| | - Iva Urbankova
- Centre for Surgical Technologies and Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Kai Su
- CSIRO Manufacturing, Bayview Avenue, Clayton, Victoria 3169, Australia
| | - Jacinta White
- CSIRO Manufacturing, Bayview Avenue, Clayton, Victoria 3169, Australia
| | - Camden Lo
- Hudson Institute of Medical Research, 27-31 Wright Street, Clayton, Victoria 3168, Australia
| | - David Alexander
- CSIRO Manufacturing, Bayview Avenue, Clayton, Victoria 3169, Australia
| | - Jerome A Werkmeister
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria 3168, Australia; CSIRO Manufacturing, Bayview Avenue, Clayton, Victoria 3169, Australia
| | - Caroline E Gargett
- Hudson Institute of Medical Research, 27-31 Wright Street, Clayton, Victoria 3168, Australia; Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria 3168, Australia.
| | - Jan Deprest
- Centre for Surgical Technologies and Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| |
Collapse
|
16
|
Todros S, Pavan PG, Natali AN. Biomechanical properties of synthetic surgical meshes for pelvic prolapse repair. J Mech Behav Biomed Mater 2015; 55:271-285. [PMID: 26615384 DOI: 10.1016/j.jmbbm.2015.10.024] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 10/26/2015] [Accepted: 10/27/2015] [Indexed: 12/27/2022]
Abstract
Synthetic meshes are widely used for surgical repair of different kind of prolapses. In the light of the experience of abdominal wall repair, similar prostheses are currently used in the pelvic region, to restore physiological anatomy after organ prolapse into the vaginal wall, that represent a recurrent dysfunction. For this purpose, synthetic meshes are surgically positioned in contact with the anterior and/or posterior vaginal wall, to inferiorly support prolapsed organs. Nonetheless, while mesh implantation restores physiological anatomy, it is often associated with different complications in the vaginal region. These potentially dangerous effects induce the surgical community to reconsider the safety and efficacy of mesh transvaginal placement. For this purpose, the evaluation of state-of-the-art research may provide the basis for a comprehensive analysis of mesh compatibility and functionality. The aim of this work is to review synthetic surgical meshes for pelvic organs prolapse repair, taking into account the mechanics of mesh material and structure, and to relate them with pelvic and vaginal tissue biomechanics. Synthetic meshes are currently available in different chemical composition, fiber and textile conformations. Material and structural properties are key factors in determining mesh biochemical and mechanical compatibility in vivo. The most significant results on vaginal tissue and surgical meshes mechanical characterization are here reported and discussed. Moreover, computational models of the pelvic region, which could support the surgeon in the evaluation of mesh performances in physiological conditions, are recalled.
Collapse
Affiliation(s)
- S Todros
- Department of Industrial Engineering, Centre for Mechanics of Biological Materials, University of Padova, via Marzolo 9, I-35131 Padova, Italy.
| | - P G Pavan
- Department of Industrial Engineering, Centre for Mechanics of Biological Materials, University of Padova, via Marzolo 9, I-35131 Padova, Italy
| | - A N Natali
- Department of Industrial Engineering, Centre for Mechanics of Biological Materials, University of Padova, via Marzolo 9, I-35131 Padova, Italy
| |
Collapse
|
17
|
Bigozzi MA, Provenzano S, Maeda F, Palma P, Riccetto C. In vivo biomechanical properties of heavy versus light weight monofilament polypropylene meshes. Does the knitting pattern matter? Neurourol Urodyn 2015; 36:73-79. [PMID: 26436858 DOI: 10.1002/nau.22890] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Accepted: 09/03/2015] [Indexed: 02/04/2023]
Abstract
AIMS This work evaluated the post-implant biomechanical properties of light-weight (LW) and heavy-weight (HW) monofilament polypropylene (PP) meshes with different knitting patterns in an animal model in vivo. METHODS Forty-five adult female Wistar rats were divided into three groups and randomly implanted with 32 × 32 mm HW-PP (62 gm-2 ) orLW-PP (16 gm-2 ) in the lower abdomen. LW-PPwas tested orthogonally (called LWL and LWT) to reproduce the longitudinal and transverse planes of the vaginal wall, respectively. Abdominal walls were removed at 7, 30, and 60 days, and then tested for tensile load (maximum load until avulsion from the tissue), deflection, and stiffness to maximum load. Explants were compared over time and between groups. RESULTS LW-PP meshes implanted in the LWT fashion (vaginal transverse plane) showed comparable maximum load and stiffness to HW-PP meshes, and LW-PP meshes implanted in the LWL fashion (vaginal longitudinal plane) presented lower maximum load and stiffness than the HW-PP meshes. There were no significant differences in the values of deflection at maximum load between the studied meshes as a function of time. CONCLUSIONS The final mechanical behavior of PP mesh can be changed by its weight and knitting pattern. These properties may be useful in making more biocompatible prostheses for pelvic organ prolapse (POP) with less foreign material to maintain longitudinal vaginal elasticity and minimize sexual symptoms while maintaining transverse resistance (i.e., between vaginal fornixes) to prevent POP recurrence. Neurourol. Urodynam. 36:73-79, 2017. © 2015 Wiley Periodicals, Inc.
Collapse
Affiliation(s)
| | | | - Fernando Maeda
- Faculty of Medical Sciences, University of Campinas (UNICAMP), Sao Paulo, Brazil
| | - Paulo Palma
- Division of Female Urology, Faculty of Medical Sciences, University of Campinas (UNICAMP), Sao Paulo, Brazil
| | - Cassio Riccetto
- Division of Female Urology, Faculty of Medical Sciences, University of Campinas (UNICAMP), Sao Paulo, Brazil
| |
Collapse
|
18
|
Mechanical biocompatibility of highly deformable biomedical materials. J Mech Behav Biomed Mater 2015; 48:100-124. [DOI: 10.1016/j.jmbbm.2015.03.023] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2014] [Revised: 03/22/2015] [Accepted: 03/24/2015] [Indexed: 12/20/2022]
|
19
|
Muscle fragments on a scaffold in rats: a potential regenerative strategy in urogynecology. Int Urogynecol J 2015. [DOI: 10.1007/s00192-015-2782-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
|
20
|
Mayer S, Decaluwe H, Ruol M, Manodoro S, Kramer M, Till H, Deprest J. Diaphragm Repair with a Novel Cross-Linked Collagen Biomaterial in a Growing Rabbit Model. PLoS One 2015; 10:e0132021. [PMID: 26147985 PMCID: PMC4493058 DOI: 10.1371/journal.pone.0132021] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Accepted: 06/09/2015] [Indexed: 12/02/2022] Open
Abstract
Background Neonates with congenital diaphragmatic hernia and large defects often require patch closure. Acellular collagen matrices (ACM) have been suggested as an alternative to synthetic durable patches as they are remodeled by the host or could also be used for tissue engineering purposes. Materials and Methods 2.0x1.0 cm diaphragmatic defects were created in 6-weeks old New-Zealand white rabbits. We compared reconstruction with a purpose-designed cross-linked ACM (Matricel) to 4-layer non-cross-linked small intestinal submucosa (SIS) and a 1-layer synthetic Dual Mesh (Gore-Tex). Unoperated animals or animals undergoing primary closure (4/0 polyglecaprone) served as age-matched controls. 60 (n = 25) resp. 90 (n = 17) days later, animals underwent chest x-ray and obduction for gross examination of explants, scoring of adhesion and inflammatory response. Also, uniaxial tensiometry was done, comparing explants to contralateral native diaphragmatic tissue. Results Overall weight nearly doubled from 1,554±242 g at surgery to 2,837±265 g at obduction (+84%). X-rays did show rare elevation of the left diaphragm (SIS = 1, Gore-Tex = 1, unoperated control = 1), but no herniation of abdominal organs. 56% of SIS and 10% of Matricel patches degraded with visceral bulging in four (SIS = 3, Matricel = 1). Adhesion scores were limited: 0.5 (Matricel) to 1 (SIS, Gore-Tex) to the left lung (p = 0.008) and 2.5 (Gore-Tex), 3 (SIS) and 4 (Matricel) to the liver (p<0.0001). Tensiometry revealed a reduced bursting strength but normal compliance for SIS. Compliance was reduced in Matricel and Gore-Tex (p<0.01). Inflammatory response was characterized by a more polymorphonuclear cell (SIS) resp. macrophage (Matricel) type of infiltrate (p<0.05). Fibrosis was similar for all groups, except there was less mature collagen deposited to Gore-Tex implants (p<0.05). Conclusions Matricel induced a macrophage-dominated inflammatory response, more adhesions, had appropriate strength but a lesser compliance compared to native tissue. The herein investigated ACM is not a viable option for CDH repair.
Collapse
Affiliation(s)
- Steffi Mayer
- Center for Surgical Technologies and Organ Systems Cluster, Department of Development and Regeneration, Faculty of Medicine, KU Leuven, Leuven, Belgium
- Department of Pediatric Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Herbert Decaluwe
- Department of Thoracic Surgery, University Hospital Gasthuisberg, KU Leuven, Leuven, Belgium
| | - Michele Ruol
- Center for Surgical Technologies and Organ Systems Cluster, Department of Development and Regeneration, Faculty of Medicine, KU Leuven, Leuven, Belgium
- Department of Pediatric Surgery, University Hospital Padua, Padua, Italy
| | - Stefano Manodoro
- Center for Surgical Technologies and Organ Systems Cluster, Department of Development and Regeneration, Faculty of Medicine, KU Leuven, Leuven, Belgium
- Department of Obstetrics and Gynecology, University Hospital Monza, Monza, Italy
| | - Manuel Kramer
- Department of Radiology, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Holger Till
- Department of Pediatric Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Jan Deprest
- Center for Surgical Technologies and Organ Systems Cluster, Department of Development and Regeneration, Faculty of Medicine, KU Leuven, Leuven, Belgium
- Department of Obstetrics and Gynecology, University Hospital Gasthuisberg, KU Leuven, Leuven, Belgium
- * E-mail:
| |
Collapse
|
21
|
Maurer M, Röhrnbauer B, Feola A, Deprest J, Mazza E. Mechanical biocompatibility of prosthetic meshes: A comprehensive protocol for mechanical characterization. J Mech Behav Biomed Mater 2014; 40:42-58. [DOI: 10.1016/j.jmbbm.2014.08.005] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Revised: 07/29/2014] [Accepted: 08/10/2014] [Indexed: 11/27/2022]
|
22
|
Gucciardo L, Ozog Y, Rusconi S, Lories R, Damink LO, Deprest J. Full thickness abdominal wall defect in growing rats as a model for congenital diaphragmatic hernia prosthetic repair. J Pediatr Surg 2014; 49:1458-65. [PMID: 25280646 DOI: 10.1016/j.jpedsurg.2014.01.058] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Revised: 12/23/2013] [Accepted: 01/16/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND Large congenital diaphragmatic hernia may require prosthetic correction. Acellular collagen matrices were introduced to avoid complications owing to the use of synthetic patches. We tested 3 different ACM for reconstruction of an abdominal wall defect in an animal model that mimics the fast growth during infancy. METHODS Pelvisoft® (CR Bard, Covington, GA) and 2 investigational ACM were used for primary reconstruction of a full thickness abdominal wall defect. 3months-old rats (n=26) were allowed to survive for 90days after implantation. Anatomical, tensiometric and histological analyses were performed. Based on good outcomes, we did the same with 1month-old rats (n=54). Unoperated rats were used for obtaining reference tensiometric values of selected native tissues. RESULTS Major wound complications were exclusively observed in 1month-old rats. All explants in both groups thinned significantly (p<0.03) and had an elastic modulus increasing over time, far above that from native tissues at 90days of life. Both investigational ACM induced a more vigorous foreign body reaction than Pelvisoft(®). CONCLUSIONS The shift from 3 to 1month-old rats was associated with wound complications. Pelvisoft® showed a better biocompatibility than the 2 investigational ACM. Passive biomechanical properties of all explants were still not comparable to that of native tissues.
Collapse
Affiliation(s)
- Léonardo Gucciardo
- Department of Development and Regeneration, Faculty of Medicine, Katholieke Universiteit Leuven, Leuven, Belgium; Department of Obstetrics and Gynecology and Engineering Research Center, University Hospital Leuven, Leuven, Belgium.
| | - Yves Ozog
- Department of Development and Regeneration, Faculty of Medicine, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Silvia Rusconi
- Department of Obstetrics and Gynecology and Engineering Research Center, University Hospital Leuven, Leuven, Belgium
| | - Rik Lories
- Department of Rheumatology, University Hospital Leuven, Leuven, Belgium; Skeletal Biology and Engineering Research Center, University Hospital Leuven, Leuven, Belgium
| | | | - Jan Deprest
- Department of Development and Regeneration, Faculty of Medicine, Katholieke Universiteit Leuven, Leuven, Belgium; Department of Obstetrics and Gynecology and Engineering Research Center, University Hospital Leuven, Leuven, Belgium.
| |
Collapse
|
23
|
Multicenter, randomized trial comparing native vaginal tissue repair and synthetic mesh repair for genital prolapse surgical treatment. Int Urogynecol J 2014; 26:335-42. [DOI: 10.1007/s00192-014-2501-z] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Accepted: 08/24/2014] [Indexed: 02/03/2023]
|
24
|
Giarenis I, Robinson D. Prevention and management of pelvic organ prolapse. F1000PRIME REPORTS 2014; 6:77. [PMID: 25343034 PMCID: PMC4166938 DOI: 10.12703/p6-77] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Pelvic organ prolapse is a highly prevalent condition in the female population, which impairs the health-related quality of life of affected individuals. Despite the lack of robust evidence, selective modification of obstetric events or other risk factors could play a central role in the prevention of prolapse. While the value of pelvic floor muscle training as a preventive treatment remains uncertain, it has an essential role in the conservative management of prolapse. Surgical trends are currently changing due to the controversial issues surrounding the use of mesh and the increasing demand for uterine preservation. The evolution of laparoscopic and robotic surgery has increased the use of these techniques in pelvic floor surgery.
Collapse
|
25
|
Hogewoning CRC, Gietelink L, Pelger RCM, Hogewoning CJA, Bekker MD, Elzevier HW. The introduction of mid-urethral slings: an evaluation of literature. Int Urogynecol J 2014; 26:229-34. [PMID: 25143007 DOI: 10.1007/s00192-014-2488-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Accepted: 08/06/2014] [Indexed: 11/26/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The objective of this study was to evaluate the degree and reliability of evidence used by manufacturers before the introduction of mid-urethral slings (MUS) onto the commercial market. Furthermore, minimum standards for marketed slings are recommended by evaluating recent suggestions for the introduction of gynecological meshes. METHODS A systematic literature search was conducted using PubMed and commercial internet search engines in order to identify slings introduced by the industry over the last decade. Moreover, manufacturers were contacted by email, mail, and phone to provide data from before the introduction of the slings onto the commercial market. Once contact had been initiated, a 6-month deadline was set for data collection. RESULTS Forty-one slings introduced between 1996 and 2012 were identified. Ten slings were described in a total of 20 studies with sample sizes varying from 10 to 368. The 41 MUS were produced by a total of 19 different companies. Seven companies never responded to recurrent emails, phone calls or other means of attempted contact. Thirty-one slings (76%) remained without any comparative pre-launch data. CONCLUSIONS Mid-urethral slings were often introduced without any scientifically proven basis or pre-launch research. The US Food and Drug Administration and the European authorities should undertake immediate action by imposing strict rules before the launch of new MUS comparable with those recently suggested for meshes used in vaginal prolapse surgery.
Collapse
Affiliation(s)
- Cornelis R C Hogewoning
- Department of Urology, Leiden University Medical Center, Postzone J3-P, P.O. Box 9600, 2300 RC, Leiden, The Netherlands,
| | | | | | | | | | | |
Collapse
|
26
|
Röhrnbauer B, Ozog Y, Egger J, Werbrouck E, Deprest J, Mazza E. Combined biaxial and uniaxial mechanical characterization of prosthetic meshes in a rabbit model. J Biomech 2013; 46:1626-32. [DOI: 10.1016/j.jbiomech.2013.04.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2013] [Revised: 04/09/2013] [Accepted: 04/14/2013] [Indexed: 01/27/2023]
|
27
|
Edwards SL, Werkmeister JA, Rosamilia A, Ramshaw JAM, White JF, Gargett CE. Characterisation of clinical and newly fabricated meshes for pelvic organ prolapse repair. J Mech Behav Biomed Mater 2013; 23:53-61. [PMID: 23651550 DOI: 10.1016/j.jmbbm.2013.04.002] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2013] [Revised: 03/29/2013] [Accepted: 04/01/2013] [Indexed: 12/23/2022]
Abstract
Clinical meshes used in pelvic organ prolapse (POP) repair are predominantly manufactured from monofilament polypropylene (PP). Complications from the use of these meshes in transvaginal kits, including mesh exposure and pain, have prompted two public health notifications by the FDA. The aim of this study was to compare several clinical PP POP meshes to new fabricated POP meshes, knitted from alternative polymers, for their mechanical properties using standard and clinically relevant multi-axial testing methods. Five new meshes were warp knitted to different architectures and weights from polyamide and polyetheretherketone monofilaments. A composite mesh of a polyamide mesh incorporating a gelatin layer was also fabricated to enable the potential delivery of cells on these meshes. Meshes were assessed for their structural characteristics and mechanical properties, using uniaxial stiffness, permanent strain, bending rigidity and multi-axial burst strength methods. Results were compared to three clinical urogynaecological polypropylene meshes: Polyform®, Gynemesh(TM)PS, and IntePro®. New fabricated meshes were uniaxially less stiff (less than 0.24 N/mm and 1.20 N/mm in toe and linear regions, respectively) than the Gynemesh (0.48 N/mm and 2.08 N/mm in toe and linear regions, respectively) and IntePro (0.57 N/mm in toe region) clinical meshes, with the gelatin coated PA mesh exhibiting lower permanent strain than Polyform clinical mesh (8.1% vs. 23.5%). New meshes had lower burst stiffness than Polyform (less than 16.9 N/mm for new meshes and 26.6N/mm for Polyform). Within the new mesh prototypes, the PA meshes, either uncoated (4.7-5.7 μN m) or with gelatin coating (16.7 μN m) possessed lower bending rigidity than both Polyform and Gynemesh (46.2 μN m and 36.4 μN m, respectively). The new fabricated mesh designs were of similar architecture, but with some improved mechanical properties, compared to clinical POP meshes. Multi-axial analysis of new and clinical mesh designs provides greater discriminatory power in analysing mesh mechanical properties for clinical applications.
Collapse
Affiliation(s)
- Sharon L Edwards
- CSIRO Materials Science and Engineering, Bayview Avenue, Clayton, Victoria 3168, Australia.
| | | | | | | | | | | |
Collapse
|
28
|
Röhrnbauer B, Mazza E. A non-biological model system to simulate the in vivo mechanical behavior of prosthetic meshes. J Mech Behav Biomed Mater 2013; 20:305-15. [DOI: 10.1016/j.jmbbm.2013.01.029] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2012] [Revised: 01/15/2013] [Accepted: 01/28/2013] [Indexed: 10/27/2022]
|
29
|
Complicaciones del tratamiento de incontinencia urinaria y prolapso de la pelvis. REVISTA MÉDICA CLÍNICA LAS CONDES 2013. [DOI: 10.1016/s0716-8640(13)70155-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
|
30
|
Bacsu C, Zimmern P. Complications of treatment of urinary incontinence and pelvic organ prolapse. REVISTA MÉDICA CLÍNICA LAS CONDES 2013. [DOI: 10.1016/s0716-8640(13)70154-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
|
31
|
Deprest J, Feola A. The need for preclinical research on pelvic floor reconstruction. BJOG 2013; 120:141-143. [PMID: 23240796 DOI: 10.1111/1471-0528.12088] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2012] [Indexed: 11/28/2022]
Affiliation(s)
- J Deprest
- Research Unit Biomechanics, Bioimplants and Tissue Engineering, Department of Development and Regeneration, Faculty of Medicine.,Pelvic Floor Unit, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - A Feola
- Research Unit Biomechanics, Bioimplants and Tissue Engineering, Department of Development and Regeneration, Faculty of Medicine
| |
Collapse
|
32
|
Manodoro S, Endo M, Uvin P, Albersen M, Vláčil J, Engels A, Schmidt B, De Ridder D, Feola A, Deprest J. Graft-related complications and biaxial tensiometry following experimental vaginal implantation of flat mesh of variable dimensions. BJOG 2012; 120:244-250. [DOI: 10.1111/1471-0528.12081] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2012] [Indexed: 12/30/2022]
Affiliation(s)
- S Manodoro
- Centre for Surgical Technologies, Faculty of Medicine; KU Leuven; Leuven Belgium
- Clinic of Obstetrics and Gynecology; University of Milan-Bicocca, San Gerardo Hospital; Monza Italy
| | - M Endo
- Centre for Surgical Technologies, Faculty of Medicine; KU Leuven; Leuven Belgium
- Department of Development and Regeneration, Faculty of Medicine; KU Leuven; Leuven Belgium
| | - P Uvin
- Department of Development and Regeneration, Faculty of Medicine; KU Leuven; Leuven Belgium
| | - M Albersen
- Department of Development and Regeneration, Faculty of Medicine; KU Leuven; Leuven Belgium
| | - J Vláčil
- Centre for Surgical Technologies, Faculty of Medicine; KU Leuven; Leuven Belgium
- Department of Development and Regeneration, Faculty of Medicine; KU Leuven; Leuven Belgium
| | - A Engels
- Centre for Surgical Technologies, Faculty of Medicine; KU Leuven; Leuven Belgium
| | - B Schmidt
- European Competence Center of Healthcare Engineering; Hemmingen Germany
| | - D De Ridder
- Department of Development and Regeneration, Faculty of Medicine; KU Leuven; Leuven Belgium
- Pelvic Floor Unit; University Hospitals Leuven; Leuven Belgium
| | - A Feola
- Centre for Surgical Technologies, Faculty of Medicine; KU Leuven; Leuven Belgium
- Department of Development and Regeneration, Faculty of Medicine; KU Leuven; Leuven Belgium
| | - J Deprest
- Centre for Surgical Technologies, Faculty of Medicine; KU Leuven; Leuven Belgium
- Department of Development and Regeneration, Faculty of Medicine; KU Leuven; Leuven Belgium
- Pelvic Floor Unit; University Hospitals Leuven; Leuven Belgium
| |
Collapse
|
33
|
Boennelycke M, Gras S, Lose G. Tissue engineering as a potential alternative or adjunct to surgical reconstruction in treating pelvic organ prolapse. Int Urogynecol J 2012; 24:883. [PMID: 22940843 DOI: 10.1007/s00192-012-2022-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Cell-based tissue engineering strategies could potentially provide attractive alternatives to surgical reconstruction of native tissue or the use of surgical implants in treating pelvic organ prolapse (POP). METHODS Based on a search in PubMed, this review focuses on candidate cell types, scaffolds, and trophic factors used in studies examining cell-based tissue engineering strategies to treat POP, stress urinary incontinence (SUI), and the closely related field of hernias. RESULTS In contrast to the field of SUI, the use of cell-based tissue engineering strategies to treat POP are very sparsely explored, and only preclinical studies exist. CONCLUSION The available evidence suggests that the use of autologous muscle-derived cells, fibroblasts, or mesenchymal stem cells seeded on biocompatible, degradable, and potentially growth-promoting scaffolds could be an alternative to surgical reconstruction of native tissue or the use of conventional implants in treating POP. However, the vagina is a complex organ with great demands of functionality, and the perfect match of scaffold, cell, and trophic factor has yet to be found and tested in preclinical studies. Important issues such as safety and economy must also be addressed before this approach is ready for clinical studies.
Collapse
Affiliation(s)
- M Boennelycke
- Department of Obstetrics and Gynecology, Copenhagen University Hospital, Herlev, Denmark
| | | | | |
Collapse
|
34
|
Boennelycke M, Gras S, Lose G. Tissue engineering as a potential alternative or adjunct to surgical reconstruction in treating pelvic organ prolapse. Int Urogynecol J 2012; 24:741-7. [PMID: 22940843 DOI: 10.1007/s00192-012-1927-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2012] [Accepted: 08/11/2012] [Indexed: 12/11/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Cell-based tissue engineering strategies could potentially provide attractive alternatives to surgical reconstruction of native tissue or the use of surgical implants in treating pelvic organ prolapse (POP). METHODS Based on a search in PubMed, this review focuses on candidate cell types, scaffolds, and trophic factors used in studies examining cell-based tissue engineering strategies to treat POP, stress urinary incontinence (SUI), and the closely related field of hernias. RESULTS In contrast to the field of SUI, the use of cell-based tissue engineering strategies to treat POP are very sparsely explored, and only preclinical studies exist. CONCLUSION The available evidence suggests that the use of autologous muscle-derived cells, fibroblasts, or mesenchymal stem cells seeded on biocompatible, degradable, and potentially growth-promoting scaffolds could be an alternative to surgical reconstruction of native tissue or the use of conventional implants in treating POP. However, the vagina is a complex organ with great demands of functionality, and the perfect match of scaffold, cell, and trophic factor has yet to be found and tested in preclinical studies. Important issues such as safety and economy must also be addressed before this approach is ready for clinical studies.
Collapse
Affiliation(s)
- M Boennelycke
- Department of Obstetrics and Gynecology, Copenhagen University Hospital, Herlev, Denmark
| | | | | |
Collapse
|