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Zhao Z, Han W, Huang G, He Y, Zuo X, Hong L. Increased extracellular matrix stiffness regulates myofibroblast transformation through induction of autophagy-mediated Kindlin-2 cytoplasmic translocation. Exp Cell Res 2024; 436:113974. [PMID: 38346630 DOI: 10.1016/j.yexcr.2024.113974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 02/03/2024] [Accepted: 02/09/2024] [Indexed: 03/11/2024]
Abstract
The extracellular matrix (ECM) mechanical properties regulate biological processes, such as fibroblast-myofibroblast transformation (FMT), which is a crucial component in pelvic organ prolapse (POP) development. The 'Kindlin-2' protein, expressed by fibroblasts, plays an important role in the development of the mesoderm, which is responsible for connective tissue formation; however, the role of Kindlin-2 in FMT remains to be explored. In this study, we aimed to explore the role of Kindlin-2 in FMT as it relates to POP. We found that ECM stiffness induces autophagy to translocate Kindlin-2 to the cytoplasm of L929 cells, where it interacts with and degrades MOB1, thereby facilitating Yes-associated protein (YAP) entry into the nucleus and influencing FMT progression. Stiffness-induced autophagy was inhibited when using an autophagy inhibitor, which blocked the translocation of Kindlin-2 to the cytoplasm and partially reversed high-stiffness-induced FMT. In patients with POP, we observed an increase in cytoplasmic Kindlin-2 and nuclear YAP levels. Similar changes in vaginal wall-associated proteins were observed in a mouse model of acute vaginal injury. In conclusion, Kindlin-2 is a key gene affecting ECM stiffness, which regulates FMT by inducing autophagy and may influence the development of POP.
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Affiliation(s)
- Zhihan Zhao
- Department of Gynecology and Obstetrics, Renmin Hospital of Wuhan University, Wuhan, 430060, Hubei Province, PR China
| | - Wuyue Han
- Department of Gynecology and Obstetrics, Renmin Hospital of Wuhan University, Wuhan, 430060, Hubei Province, PR China
| | - Guotao Huang
- Department of Gynecology and Obstetrics, Renmin Hospital of Wuhan University, Wuhan, 430060, Hubei Province, PR China
| | - Yong He
- Department of Gynecology and Obstetrics, Renmin Hospital of Wuhan University, Wuhan, 430060, Hubei Province, PR China
| | - Xiaohu Zuo
- Department of Gynecology and Obstetrics, Renmin Hospital of Wuhan University, Wuhan, 430060, Hubei Province, PR China
| | - Li Hong
- Department of Gynecology and Obstetrics, Renmin Hospital of Wuhan University, Wuhan, 430060, Hubei Province, PR China.
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Houshyar S, Saha T, Yin H, Zizhou R, Dekiwadia C, Pirogova E, Hill-Yardin EL, Yeung JM, Fox K, Cole I. Advanced flexible transvaginal mesh with high visibility under computerized tomography (CT) scan. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2023; 2023:1-4. [PMID: 38083162 DOI: 10.1109/embc40787.2023.10340322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Pelvic floor disorders, including pelvic organ prolapse (POP) and stress urinary incontinence (SUI), are serious and very common. Surgery is commonly undertaken to restore the strength of the vaginal wall using transvaginal surgical mesh (TVM). However, up to 15% of TVM implants result in long-term complications, including pain, recurrent symptoms, and infection.Clinical Relevance- In this study, a new bioengineered TVM has been developed to address these issues. The TVM is visible using noninvasive imaging techniques such as computed tomography (CT); it has a highly similar structural profile to human tissue and potential to reduce pain and inflammation. These combined technological advances have the potential to revolutionize women's health.
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Wang X, Chen Y, Fan Z, Hua K. Evaluating tissue-engineered repair material for pelvic floor dysfunction: a comparison of in vivo response to meshes implanted in rats. Int Urogynecol J 2021; 33:2143-2150. [PMID: 34741620 DOI: 10.1007/s00192-021-05008-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 10/04/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Achieving better anatomic restoration and decreasing the associated complications are necessary for material repair of pelvic floor dysfunction (PFD). This study was aimed to investigate host response to tissue-engineered repair material (TERM) in rat models by comparing different materials and study the changes in biomechanical properties over time. METHODS TERM was constructed by seeding adipose-derived stem cells (ADSCs) on electrospun poly(L-lactide)-trimethylene carbonate-glycolide (PLTG) terpolymers. The TERM, PLTG, porcine small intestine submucosa mesh (SIS), and polypropylene (PP) (n = 6 / group per time point) were implanted in rats for 7, 30, 60, and 90 days. Hematoxylin-eosin and Masson's trichrome staining were used to assess the host response, and mechanical testing was used to evaluate the changes in biomechanical properties. RESULTS In vivo imaging showed that the ADSCs were confined to the abdominal wall and did not migrate to other organs or tissues. The TERM was encapsulated by a thicker layer of connective tissue and was associated with less reduced inflammatory scores compared with PLTG and PP over time. The vascularization of the TERM was greater than that with PP and PLTG over time (p < 0.05) and was greater than that with SIS on day 90. The ultimate tensile strain and Young's modulus of the PP group showed the greatest increases, and the TERM group followed on day 90. CONCLUSIONS This TERM achieved better host integration in rat models and better biomechanical properties, and it may be an alternative material for PFD.
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Affiliation(s)
- Xiaojuan Wang
- Department of Gynecology, Obstetrics and Gynecology Hospital, Fudan University, 128 Shenyang Road, Shanghai, 200090, People's Republic of China
| | - Yisong Chen
- Department of Gynecology, Obstetrics and Gynecology Hospital, Fudan University, 128 Shenyang Road, Shanghai, 200090, People's Republic of China
| | - Zhongyong Fan
- Department of Materials Science, Fudan University, No. 220 Handan Road, Shanghai, 200433, People's Republic of China
| | - Keqin Hua
- Department of Gynecology, Obstetrics and Gynecology Hospital, Fudan University, 128 Shenyang Road, Shanghai, 200090, People's Republic of China.
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Li H, Shu H, Qiao G, Dai Z. Visualization of implanted mesh in the pelvic reconstructive surgery using an X-ray-detectable thread. Arch Gynecol Obstet 2021; 304:965-973. [PMID: 34405286 DOI: 10.1007/s00404-021-06180-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 08/04/2021] [Indexed: 02/08/2023]
Abstract
PURPOSE Visualization of the implanted mesh after a pelvic floor repair surgery is important for evaluating mesh-related complications. We made an X-ray-detectable mesh and studied the histocompatibility and toxicity of it. METHODS A thin barium sulfate thread was weaved on a traditional polypropylene mesh to make it X-ray detectable. The cytotoxicity of the mesh was tested by the MTT assay on L929 cell line. The histocompatibility and toxicity of mesh were evaluated in rabbits. Meshes were first implanted intraperitoneally. On postoperative day 7, bloods were tested to estimate the acute toxicity of meshes. After 6 months, rabbits were sacrificed and local inflammatory reaction and tissue regeneration at implantation sites were estimated by the HE stain and Masson stain. In addition, CT scans were performed after surgeries to display the location and shape of implanted meshes. RESULTS Compared to the polypropylene mesh group, no significant difference was observed in the X-ray-detectable mesh group on both in vitro cytotoxicity and in vivo acute and chronic toxicity. The amounts of extra cellular matrix between two groups did not differ. Through CT scan and 3D remodeling, the barium sulfate thread clearly revealed the position and shape of the X-ray-detectable mesh, whereas the traditional mesh was invisible under CT scan. CONCLUSION Adding a thin barium sulfate thread on the polypropylene mesh does not change its histocompatibility or toxicity in rabbit model. The barium sulfate thread can effectively show the location and shape of implanted mesh under CT scan.
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Affiliation(s)
- Hui Li
- Department of Gynecology, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, No. 2699, West Gaoke Road, Pudong New District, Shanghai, 201204, China
| | - Huimin Shu
- Department of Gynecology, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, No. 2699, West Gaoke Road, Pudong New District, Shanghai, 201204, China
| | - Guangfang Qiao
- Department of Gynecology, Songjiang Maternity and Child Health Hospital, Shanghai, China
| | - Zhiyuan Dai
- Department of Gynecology, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, No. 2699, West Gaoke Road, Pudong New District, Shanghai, 201204, China.
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O'Shaughnessy D, Grande D, El-Neemany D, Sajjan S, Pillalamarri N, Shalom D, Winkler H. Evaluation of the histological and biomechanical properties of poly-4-hydroxybutyrate scaffold for pelvic organ prolapse, compared with polypropylene mesh in a rabbit model. Int Urogynecol J 2021; 33:2213-2220. [PMID: 34125243 DOI: 10.1007/s00192-021-04851-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Accepted: 05/09/2021] [Indexed: 11/24/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Poly-4-hydroxybutyrate (P4HB) is a biopolymer produced by Escherichia coli K12 bacteria. P4HB is fully resorbed in vivo by 18-24 months post-implantation. The aim of this study is to evaluate P4HB in the rabbit abdomen and vagina to determine that the biomechanical and histological properties are similar to the standard polypropylene mesh. Our hypothesis is that the histological and biomechanical properties of a fully absorbable graft will be similar to a lightweight polypropylene (PP) mesh when implanted in rabbit vagina and abdomen. METHODS Sixteen (n = 16) female New Zealand White (retired breeder) rabbits were equally divided between two time points (3 and 9 months). A total of 17 rabbits were used owing to one death secondary to suspected cardiomyopathy. P4HB scaffold and PP mesh were subcutaneously and peri-vaginally implanted into the rabbit abdomen and vagina respectively. All rabbits had both posterior and anterior vaginal implants, and half of the rabbits had four abdominal implants in addition to the vaginal implants. The abdominal implants were 4.5 cm long × 1.5 cm wide whereas the vaginal implants were 1.5 cm long × 0.5 cm wide. At 3 and 9 months, gross necropsy was performed and samples were obtained, sectioned, stained and evaluated via histological analysis. Specimens were assessed for host inflammatory response, neovascularization, elastin content, and collagen deposition/maturation. Specimens were also biomechanically evaluated via uniaxial tensile test to determine the stiffness, ultimate tensile strength and load at ultimate tensile strength of the device/tissue composite. RESULTS No abdominal mesh exposures were noted. A comparable number of asymptomatic partial vaginal exposures were observed at 3 months (P4HB: n = 3; PP: n = 2) and 9 months (P4HB: n = 3; PP: n = 2) respectively. Histological analysis of specimens showed comparable results in the P4HB and PP groups at 3 and 9 months post-implantation. Although no acute inflammation was seen, chronic inflammation was demonstrated in all specimens. Elastic fibers were present in the 3-month vaginal PP and P4HB specimens, but were not seen again. There was an increase in type I/III collagen noted over time. Biomechanical evaluation of the vaginal mesh tissue complex showed ultimate tensile strength was not significantly different between P4HB and PP groups at 3 (P = 0.625) and 9 months (P = 0.250) respectively. CONCLUSIONS P4HB scaffold may represent a fully absorbable alternative to permanent mesh for pelvic organ prolapse (POP) repair.
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Affiliation(s)
- Danielle O'Shaughnessy
- Division of Female Pelvic Medicine and Reconstructive Surgery, Donald and Barbara Zucker School of Medicine at Northwell Health, Long Island, NY, USA.
| | - Daniel Grande
- The Feinstein Institute of Medical Research at Northwell Health, Manhasset, NY, USA
| | - Diana El-Neemany
- Division of Female Pelvic Medicine and Reconstructive Surgery, Donald and Barbara Zucker School of Medicine at Northwell Health, Long Island, NY, USA
| | - Sujata Sajjan
- Department of Pathology, Donald and Barbara Zucker School of Medicine at Northwell Health, Manhasset, NY, USA
| | - Nirmala Pillalamarri
- Division of Female Pelvic Medicine and Reconstructive Surgery, Donald and Barbara Zucker School of Medicine at Northwell Health, Long Island, NY, USA
| | - Dara Shalom
- Division of Female Pelvic Medicine and Reconstructive Surgery, Donald and Barbara Zucker School of Medicine at Northwell Health, Long Island, NY, USA
| | - Harvey Winkler
- Division of Female Pelvic Medicine and Reconstructive Surgery, Donald and Barbara Zucker School of Medicine at Northwell Health, Long Island, NY, USA
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Morch A, Doucède G, Lecomte-Grosbras P, Brieu M, Rubod C, Cosson M. Pelvic organ prolapse meshes: Can they preserve the physiological behavior? J Mech Behav Biomed Mater 2021; 120:104569. [PMID: 34058600 DOI: 10.1016/j.jmbbm.2021.104569] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 11/24/2020] [Accepted: 05/02/2021] [Indexed: 10/21/2022]
Abstract
Implants for the cure of female genital prolapse still show numerous complications cases that sometimes have dramatic consequences. These implants must be improved to provide physiological support and restore the normal functionalities of the pelvic area. Besides the trend towards lighter meshes, a better understanding of the in vivo role and impact of the mesh implantation is required. This work investigates the mechanical impact of meshes after implantation with regards to the behavior of the native tissues. Three meshes were studied to assess their mechanical and biological impact on the native tissues. An animal study was conducted on rats. Four groups (n = 17/group) underwent surgery. Rats were implanted on the abdominal wall with one of the three polypropylene knitted mesh (one mesh/group). The last group served as control and underwent the same surgery without any mesh implantation. Post-operative complications, contraction, mechanical rigidities, and residual deformation after cyclic loading were collected. Non-parametric statistical comparisons were performed (Kruskal-Wallis) to observe potential differences between implanted and control groups. Mechanical characterization showed that one of the three meshes did not alter the mechanical behavior of the native tissues. On the contrary, the two others drastically increased the rigidities and were also associated with clinical complications. All of the meshes seem to reduce the geometrical lengthening of the biological tissues that comes with repetitive loads. Mechanical aspects might play a key role in the compatibility of the mesh in vivo. One of the three materials that were implanted during an animal study seems to provide better support and adapt more properly to the physiological behavior of the native tissues.
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Affiliation(s)
- Annie Morch
- Univ. Lille, CNRS, Centrale Lille, UMR 9013- LaMcube - Laboratoire de Mécanique, Multiphysique, Multi-échelle, F-59000, Lille, France
| | - Guillaume Doucède
- Service de Chirurgie gynécologique - CHU Lille, F-59000, Lille, France; Université de Lille - Faculté de Lille, F-59000, Lille, France
| | - Pauline Lecomte-Grosbras
- Univ. Lille, CNRS, Centrale Lille, UMR 9013- LaMcube - Laboratoire de Mécanique, Multiphysique, Multi-échelle, F-59000, Lille, France
| | - Mathias Brieu
- Univ. Lille, CNRS, Centrale Lille, UMR 9013- LaMcube - Laboratoire de Mécanique, Multiphysique, Multi-échelle, F-59000, Lille, France; California State University - Los Angeles, College Engineering - Computer Science, and Technology, Dept. Mechanical Engineering, United States
| | - Chrystèle Rubod
- Univ. Lille, CNRS, Centrale Lille, UMR 9013- LaMcube - Laboratoire de Mécanique, Multiphysique, Multi-échelle, F-59000, Lille, France; Service de Chirurgie gynécologique - CHU Lille, F-59000, Lille, France; Université de Lille - Faculté de Lille, F-59000, Lille, France
| | - Michel Cosson
- Univ. Lille, CNRS, Centrale Lille, UMR 9013- LaMcube - Laboratoire de Mécanique, Multiphysique, Multi-échelle, F-59000, Lille, France; Service de Chirurgie gynécologique - CHU Lille, F-59000, Lille, France; Université de Lille - Faculté de Lille, F-59000, Lille, France.
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7
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Le Ruyet A, Yurtkap Y, Hartog FPJD, Vegleur A, Turquier F, Lange JF, Kleinrensink GJ. Differences in biomechanics of abdominal wall closure with and without mesh reinforcement: A study in post mortem human specimens. J Mech Behav Biomed Mater 2020; 105:103683. [PMID: 32090893 DOI: 10.1016/j.jmbbm.2020.103683] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 01/13/2020] [Accepted: 02/06/2020] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Small bites for the closure of the abdominal wall after midline laparotomy result in significantly less incisional hernias in comparison with large bites. However, fundamental knowledge of underlying biomechanical phenomena remains sparse. The objective of this study was to develop a digital image correlation-based method to compare different suturing techniques in terms of strain pattern after closure of a midline laparotomy in a passive model just after the time of surgery. METHODS A digital image correlation (DIC)-based method was used for the comparison of strain fields on the external surface of the myofascial abdominal wall (skin and subcutaneous fat removed) among six configurations, including an intact linea alba in five post mortem human specimens. The second configuration comprised primary mass closure with small bites (five mm between two consecutive stitches and five mm distance from the incision, 5x5 mm). The third configuration was primary mass closure with large bites (ten mm by ten mm, 10x10 mm). The fourth, fifth and sixth configuration comprised primary mass closure with large bites and the placement of a mesh in onlay position with two different overlaps and the use of glue to simulate the integration of the mesh within the soft tissue. RESULTS No visible difference was observed between 5x5 and 10x10 mm closure configurations. However, the use of mesh as suture line reinforcement highlighted a stiffer behavior of the midline area for similar intra-abdominal pressure, which was amplified when a larger mesh overlap was used. However, the whole abdominal wall showed quite similar shapes for the various configurations, except for the configuration with mesh reinforcement and the use of glue. CONCLUSION Mesh reinforcement incited lower opening tension profiles in the midline area of the abdominal wall. following closure of the linea alba in median laparotomy. The next step should be to investigate the impact of mesh location (e.g. retromuscular) and different time points after surgery.
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Affiliation(s)
- A Le Ruyet
- Medtronic, Sofradim Production, Trévoux, France.
| | - Y Yurtkap
- Department of Surgery, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - F P J den Hartog
- Department of Surgery, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - A Vegleur
- Medtronic, Sofradim Production, Trévoux, France
| | - F Turquier
- Medtronic, Sofradim Production, Trévoux, France
| | - J F Lange
- Department of Surgery, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - G J Kleinrensink
- Department of Neuroscience and Anatomy, Erasmus University Medical Centre, Rotterdam, the Netherlands
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Transvaginal treatment of anterior and apical genital prolapse using Restorelle® direct fix™: An observational study of medium-term complications and outcomes. J Gynecol Obstet Hum Reprod 2020; 49:101674. [DOI: 10.1016/j.jogoh.2019.101674] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 12/04/2019] [Accepted: 12/08/2019] [Indexed: 11/22/2022]
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9
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Mancuso E, Downey C, Doxford‐Hook E, Bryant MG, Culmer P. The use of polymeric meshes for pelvic organ prolapse: Current concepts, challenges, and future perspectives. J Biomed Mater Res B Appl Biomater 2019; 108:771-789. [DOI: 10.1002/jbm.b.34432] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 05/07/2019] [Accepted: 05/31/2019] [Indexed: 12/18/2022]
Affiliation(s)
- Elena Mancuso
- Ulster UniversityNanotechnology and Integrated Bio‐Engineering Centre (NIBEC) Jordanstown campus ‐ Newtownabbey UK
| | - Candice Downey
- Leeds Institute of Medical Research at St James'sUniversity of Leeds Leeds UK
| | | | | | - Peter Culmer
- School of Mechanical EngineeringUniversity of Leeds Leeds UK
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Abstract
Stress urinary incontinence (SUI) and pelvic organ prolapse (POP) are conditions which result in significant physical, mental and social consequences for women worldwide. The high rates of recurrence reported with primary repair for POP led to the use of synthetic mesh to augment repairs in both primary and secondary cases following failed previous POP repair. The widely reported, unacceptably high rates of complications associated with the use of synthetic, transvaginal mesh in pelvic floor repair have severely limited the treatment options that surgeons can offer. This article summarises the recent advances in pelvic floor repair, such as improved quantification and modelling of the biomechanics of the pelvic floor and the developing technology within the field of tissue engineering for treatment of SUI/POP, including biomaterials and cell-based therapies. Finally, we will discuss the issues surrounding the commercial introduction of synthetic mesh for use within the pelvic floor and what lessons can be learned for the future as well as the current guidance surrounding treatment for SUI/POP.
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Affiliation(s)
- Emma Mironska
- Department of Materials Science and Engineering, Kroto Research Institute, University of Sheffield, Red Hill, Sheffield, S37HQ, UK
| | - Christopher Chapple
- Urology Department, Royal Hallamshire Hospital, Glossop Road, Sheffield, S10 2JF, UK
| | - Sheila MacNeil
- Department of Materials Science and Engineering, Kroto Research Institute, University of Sheffield, Red Hill, Sheffield, S37HQ, UK
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Does Mesh Weight Affect Time to Failure After Robotic-Assisted Laparoscopic Sacrocolpopexy? Female Pelvic Med Reconstr Surg 2018; 26:536-540. [DOI: 10.1097/spv.0000000000000632] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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12
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Lu Y, Dong S, Zhang P, Liu X, Wang X. Preparation of a polylactic acid knitting mesh for pelvic floor repair and in vivo evaluation. J Mech Behav Biomed Mater 2017; 74:204-213. [DOI: 10.1016/j.jmbbm.2017.05.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 05/23/2017] [Accepted: 05/29/2017] [Indexed: 10/19/2022]
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13
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Emmerson S, Young N, Rosamilia A, Parkinson L, Edwards SL, Vashi AV, Davies-Tuck M, White J, Elgass K, Lo C, Arkwright J, Werkmeister JA, Gargett CE. Ovine multiparity is associated with diminished vaginal muscularis, increased elastic fibres and vaginal wall weakness: implication for pelvic organ prolapse. Sci Rep 2017; 7:45709. [PMID: 28374826 PMCID: PMC5379562 DOI: 10.1038/srep45709] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 03/03/2017] [Indexed: 12/26/2022] Open
Abstract
Pelvic Organ Prolapse (POP) is a major clinical burden affecting 25% of women, with vaginal delivery a major contributing factor. We hypothesised that increasing parity weakens the vagina by altering the extracellular matrix proteins and smooth muscle thereby leading to POP vulnerability. We used a modified POP-quantification (POP-Q) system and a novel pressure sensor to measure vaginal wall weakness in nulliparous, primiparous and multiparous ewes. These measurements were correlated with histological, biochemical and biomechanical properties of the ovine vagina. Primiparous and multiparous ewes had greater displacement of vaginal tissue compared to nulliparous at points Aa, Ap and Ba and lower pressure sensor measurements at points equivalent to Ap and Ba. Vaginal wall muscularis of multiparous ewes was thinner than nulliparous and had greater elastic fibre content. Collagen content was lower in primiparous than nulliparous ewes, but collagen organisation did not differ. Biomechanically, multiparous vaginal tissue was weaker and less stiff than nulliparous. Parity had a significant impact on the structure and function of the ovine vaginal wall, as the multiparous vaginal wall was weaker and had a thinner muscularis than nulliparous ewes. This correlated with "POP-Q" and pressure sensor measurements showing greater tissue laxity in multiparous compared to nulliparous ewes.
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Affiliation(s)
- Stuart Emmerson
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, 3168, Australia.,Monash University, Department of Obstetrics and Gynaecology, Clayton, Victoria, 3168, Australia
| | | | - Anna Rosamilia
- Monash University, Department of Obstetrics and Gynaecology, Clayton, Victoria, 3168, Australia.,Monash Health, Clayton, Victoria, 3168, Australia
| | - Luke Parkinson
- School of Computer Science, Engineering and Mathematics, Flinders University, Bedford Park, South Australia 5042, Australia
| | | | | | - Miranda Davies-Tuck
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, 3168, Australia.,Monash University, Department of Obstetrics and Gynaecology, Clayton, Victoria, 3168, Australia
| | - Jacinta White
- CSIRO Manufacturing, Clayton, Victoria, 3168, Australia
| | - Kirstin Elgass
- MicroImaging, Hudson Institute of Medical Research, Clayton, Victoria, 3168, Australia
| | - Camden Lo
- MicroImaging, Hudson Institute of Medical Research, Clayton, Victoria, 3168, Australia
| | - John Arkwright
- School of Computer Science, Engineering and Mathematics, Flinders University, Bedford Park, South Australia 5042, Australia
| | - Jerome A Werkmeister
- Monash University, Department of Obstetrics and Gynaecology, Clayton, Victoria, 3168, Australia.,CSIRO Manufacturing, Clayton, Victoria, 3168, Australia
| | - Caroline E Gargett
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, 3168, Australia.,Monash University, Department of Obstetrics and Gynaecology, Clayton, Victoria, 3168, Australia
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Shi Y, Yu Y, Zhang X, Li Y. Transvaginal Mesh and Transanal Resection to Treat Outlet Obstruction Constipation Caused by Rectocele. Med Sci Monit 2017; 23:598-605. [PMID: 28146137 PMCID: PMC5299970 DOI: 10.12659/msm.898790] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Background The aim of this study was to evaluate the curative effect of transvaginal mesh repair (TVMR) and stapled transanal rectal resection (STARR) in treating outlet obstruction constipation caused by rectocele. Material/Methods Patients who had outlet obstruction constipation caused by rectocele were retrospectively analyzed and 39 patients were enrolled the study. Patients were assigned to either the TVMR or STARR group. Postoperative factors such as complications, pain, recurrence rate, and operative time were compared between the 2 groups. Results Total effective rate was 100% in both groups. No long-term chronic pain occurred and discomfort rate of tenesmus was higher in the STARR group than in the TVMR group. Postoperative defecography showed that the rectocele depth was significantly reduced, and the prolapse of the rectal mucosa and the lower rectal capacity was also decreased. Four cases had mesh exposure in the TVMR group and 2 cases in the STARR group had anastomotic bleeding after the surgery. Conclusions For outlet obstruction constipation caused by rectocele, TVMR and STARR both obtained satisfactory results. Although TVMR is complex with longer operative time and hospitalization period, its long-term effect is better than that of STARR.
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Affiliation(s)
- Yang Shi
- Department of Colorectal Surgery, Tianjin Union Medicine Center, Tianjin, China (mainland)
| | - Yongjun Yu
- Department of Colorectal Surgery, Tianjin Union Medicine Center, Tianjin, China (mainland)
| | - Xipeng Zhang
- Department of Colorectal Surgery, Tianjin Union Medicine Center, Tianjin, China (mainland)
| | - Yuwei Li
- Department of Colorectal Surgery, Tianjin Union Medicine Center, Tianjin, China (mainland)
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Balgobin S, Fitzwater JL, McIntire DD, Delgado IJ, Wai CY. Effect of mesh width on apical support after sacrocolpopexy. Int Urogynecol J 2016; 28:1153-1158. [PMID: 28035443 DOI: 10.1007/s00192-016-3250-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 12/13/2016] [Indexed: 02/03/2023]
Abstract
INTRODUCTION AND HYPOTHESIS We evaluated the effect of polypropylene mesh width on vaginal apical support, mesh elongation, and mesh tensile strength for abdominal sacrocolpopexy. METHODS Abdominal sacrocolpopexy was performed on ten cadavers using pieces of polypropylene mesh of width 1, 2, and 3 cm. Weights of 1, 2, 3, and 4 kg were sequentially applied to the vagina. The total distance moved by the vaginal apex, and the amount of stretch of the intervening mesh segment between the sacrum and the vagina were recorded for each width. The failure strengths of additional single and double layer sets of each width were also tested using a tensiometer. Data were analyzed with analysis of variance using a random effects model. RESULTS The mean (standard error of the mean) maximum distance moved by the vaginal apex was 4.63 cm (0.37 cm) for the 1 cm mesh compared to 3.67 cm (0.26 cm) and 2.73 cm (0.14 cm) for the 2 and 3 cm meshes, respectively (P < 0.0001). The 1 cm width ruptured during testing in four of the ten cadavers. The results were similar for mesh elongation, with the 1 cm mesh stretching the most and the 3 cm mesh stretching the least. Mesh failure loads for double-layer mesh were 52.9 N (2.5 N), 124.4 N (2.7 N), and 201.2 N (4.5 N) for the 1, 2, and 3 cm meshes, respectively, and were higher than the failure loads for single mesh (P < 0.001). CONCLUSIONS In a cadaver model, increasing mesh width is associated with better vaginal apical support, less mesh elongation, and higher failure loads. Mesh widths of 2-3 cm provide sufficient repair strength for sacrocolpopexy.
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Affiliation(s)
- Sunil Balgobin
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-9032, USA.
| | - Joseph L Fitzwater
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-9032, USA
| | - Donald D McIntire
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-9032, USA
| | - Imelda J Delgado
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Clifford Y Wai
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-9032, USA
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Hellström M, Bandstein S, Brännström M. Uterine Tissue Engineering and the Future of Uterus Transplantation. Ann Biomed Eng 2016; 45:1718-1730. [PMID: 27995397 PMCID: PMC5489617 DOI: 10.1007/s10439-016-1776-2] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 12/07/2016] [Indexed: 12/11/2022]
Abstract
The recent successful births following live donor uterus transplantation are proof-of-concept that absolute uterine factor infertility is a treatable condition which affects several hundred thousand infertile women world-wide due to a dysfunctional uterus. This strategy also provides an alternative to gestational surrogate motherhood which is not practiced in most countries due to ethical, religious or legal reasons. The live donor surgery involved in uterus transplantation takes more than 10 h and is then followed by years of immunosuppressive medication to prevent uterine rejection. Immunosuppression is associated with significant adverse side effects, including nephrotoxicity, increased risk of serious infections, and diabetes. Thus, the development of alternative approaches to treat absolute uterine factor infertility would be desirable. This review discusses tissue engineering principles in general, but also details strategies on how to create a bioengineered uterus that could be used for transplantation, without risky donor surgery and any need for immunosuppression. We discuss scaffolds derived from decellularized organs/tissues which may be recellularized using various types of autologous somatic/stem cells, in particular for uterine tissue engineering. It further highlights the hurdles that lay ahead in developing an alternative to an allogeneic source for uterus transplantation.
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Affiliation(s)
- Mats Hellström
- Laboratory for Transplantation and Regenerative Medicine, Department of Obstetrics and Gynecology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. .,, Kvinnokliniken, Blå stråket 6, 413 45, Göteborg, Sweden.
| | - Sara Bandstein
- Laboratory for Transplantation and Regenerative Medicine, Department of Obstetrics and Gynecology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,, Kvinnokliniken, Blå stråket 6, 413 45, Göteborg, Sweden
| | - Mats Brännström
- Laboratory for Transplantation and Regenerative Medicine, Department of Obstetrics and Gynecology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,, Kvinnokliniken, Blå stråket 6, 413 45, Göteborg, Sweden
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Emmerson SJ, Gargett CE. Endometrial mesenchymal stem cells as a cell based therapy for pelvic organ prolapse. World J Stem Cells 2016; 8:202-215. [PMID: 27247705 PMCID: PMC4877564 DOI: 10.4252/wjsc.v8.i5.202] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 12/23/2015] [Accepted: 02/16/2016] [Indexed: 02/07/2023] Open
Abstract
Pelvic organ prolapse (POP) occurs when the pelvic organs (bladder, bowel or uterus) herniate into the vagina, causing incontinence, voiding, bowel and sexual dysfunction, negatively impacting upon a woman’s quality of life. POP affects 25% of all women and results from childbirth injury. For 19% of all women, surgical reconstructive surgery is required for treatment, often augmented with surgical mesh. The surgical treatment fails in up to 30% of cases or results in adverse effects, such as pain and mesh erosion into the bladder, bowel or vagina. Due to these complications the Food and Drug Administration cautioned against the use of vaginal mesh and several major brands have been recently been withdrawn from market. In this review we will discuss new cell-based approaches being developed for the treatment of POP. Several cell types have been investigated in animal models, including a new source of mesenchymal stem/stromal cells (MSC) derived from human endometrium. The unique characteristics of endometrial MSC, methods for their isolation and purification and steps towards their development for good manufacturing practice production will be described. Animal models that could be used to examine the potential for this approach will also be discussed as will a rodent model showing promise in developing an endometrial MSC-based therapy for POP. The development of a preclinical large animal model for assessing tissue engineering constructs for treating POP will also be mentioned.
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