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Sueters J, Groenman FA, Bouman MB, Roovers JPW, de Vries R, Smit TH, Huirne JAF. Tissue Engineering Neovagina for Vaginoplasty in Mayer-Rokitansky-Küster-Hauser Syndrome and Gender Dysphoria Patients: A Systematic Review. TISSUE ENGINEERING. PART B, REVIEWS 2023; 29:28-46. [PMID: 35819292 DOI: 10.1089/ten.teb.2022.0067] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background: Vaginoplasty is a surgical solution to multiple disorders, including Mayer-Rokitansky-Küster-Hauser syndrome and male-to-female gender dysphoria. Using nonvaginal tissues for these reconstructions is associated with many complications, and autologous vaginal tissue may not be sufficient. The potential of tissue engineering for vaginoplasty was studied through a systematic bibliography search. Cell types, biomaterials, and signaling factors were analyzed by investigating advantages, disadvantages, complications, and research quantity. Search Methods: A systematic search was performed in Medline, EMBASE, Web of Science, and Scopus until March 8, 2022. Term combinations for tissue engineering, guided tissue regeneration, regenerative medicine, and tissue scaffold were applied, together with vaginoplasty and neovagina. The snowball method was performed on references and a Google Scholar search on the first 200 hits. Original research articles on human and/or animal subjects that met the inclusion (reconstruction of vaginal tissue and tissue engineering method) and no exclusion criteria (not available as full text; written in foreign language; nonoriginal study article; genital surgery other than neovaginal reconstruction; and vaginal reconstruction with autologous or allogenic tissue without tissue engineering or scaffold) were assessed. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist, the Newcastle-Ottawa Scale, and the Gold Standard Publication Checklist were used to evaluate article quality and bias. Outcomes: A total of 31 out of 1569 articles were included. Data extraction was based on cell origin and type, biomaterial nature and composition, host species, number of hosts and controls, neovaginal size, replacement fraction, and signaling factors. An overview of used tissue engineering methods for neovaginal formation was created, showing high variance of cell types, biomaterials, and signaling factors and the same topics were rarely covered multiple times. Autologous vaginal cells and extracellular matrix-based biomaterials showed preferential properties, and stem cells carry potential. However, quality confirmation of orthotopic cell-seeded acellular vaginal matrix by clinical trials is needed as well as exploration of signaling factors for vaginoplasty. Impact statement General article quality was weak to sufficient due to unreported cofounders and incomplete animal study descriptions. Article quality and heterogenicity made identification of optimal cell types, biomaterials, or signaling factors unreliable. However, trends showed that autologous cells prevent complications and compatibility issues such as healthy cell destruction, whereas stem cells prevent cross talk (interference of signaling pathways by signals from other cell types) and rejection (but need confirmation testing beyond animal trials). Natural (orthotopic) extracellular matrix biomaterials have great preferential properties that encourage future research, and signaling factors for vascularization are important for tissue engineering of full-sized neovagina.
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Affiliation(s)
- Jayson Sueters
- Department of Gynaecology and Amsterdam Reproduction and Development, Amsterdam UMC location VUmc, Amsterdam, The Netherlands
| | - Freek A Groenman
- Department of Obstetrics and Gynecology, Amsterdam Reproduction and Development, Amsterdam UMC location VUmc, Amsterdam, The Netherlands.,Centre of Expertise on Gender Dysphoria, Amsterdam UMC location VUmc, Amsterdam, The Netherlands
| | - Mark-Bram Bouman
- Centre of Expertise on Gender Dysphoria, Amsterdam UMC location VUmc, Amsterdam, The Netherlands.,Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC location VUmc, Amsterdam, The Netherlands
| | - Jan Paul W Roovers
- Department of Obstetrics and Gynecology, Amsterdam Reproduction and Development, Amsterdam UMC location VUmc, Amsterdam, The Netherlands
| | - Ralph de Vries
- Medical Library, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Theo H Smit
- Department of Gynaecology and Amsterdam Reproduction and Development, Amsterdam UMC location VUmc, Amsterdam, The Netherlands.,Department of Medical Biology, Amsterdam UMC location AMC, Amsterdam, The Netherlands
| | - Judith A F Huirne
- Department of Gynaecology and Amsterdam Reproduction and Development, Amsterdam UMC location VUmc, Amsterdam, The Netherlands.,Research Institute Reproduction and Development, Amsterdam UMC location AMC, Amsterdam, The Netherlands
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Isali I, Khalifa AO, Shankar S, Dannemiller S, Horne W, Evancho-Chapman M, McClellan P, MacLennan GT, Akkus O, Hijaz A. Comparison of Morphological and Histological Characteristics of Human and Sheep: Sheep as a Potential Model for Testing Midurethral Slings in vivo. Urol Int 2022; 107:422-428. [PMID: 35220315 PMCID: PMC10123539 DOI: 10.1159/000522138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 01/18/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The sheep was evaluated as a potential model for preclinical evaluation of urethral slings in vivo based on: (1) anatomical measurements of the sheep vagina and (2) histological tissue integration and host response to polypropylene (PP) slings. METHODS Eight female, multiparous sheep were utilized. Three of 8 animals underwent surgery mimicking human tension-free vaginal tape protocols for midurethral slings and were euthanized at 6 months. The following measurements were obtained: vaginal length, maximum vaginal width with retraction, symphysis pubis length, and distance from the pubic bone to incision. Explanted sling samples from sheep and human were stained with hematoxylin and eosin for host reaction assessment. RESULTS Geometric measurements were similar between humans and sheep. Sheep vaginal anatomy allowed sling placement similar to procedures in human surgeries, and all sheep recovered without problems. Comparative histology between the sheep and human indicated similar host reaction and collagen deposition around implants, confirming suitability of the sheep model for biomaterial response assessment. CONCLUSION Sheep vaginal length is comparable to humans. Tissue integration and host response to PP slings showed chronic inflammation with rich collagen deposition around the material in both sheep and human specimens, highlighting the sheep as a potential animal model for preclinical testing of midurethral slings.
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Affiliation(s)
- Ilaha Isali
- Department of Urology, Case Western Reserve University, Cleveland, Ohio, USA,
| | - Ahmad Osama Khalifa
- Department of Urology, Colchester Hospital University, East Suffolk and North Essex NHS Foundation Trust, Colchester, UK
| | | | - Stanley Dannemiller
- Comparative Medicine Unit, Northeast Ohio Medical University, Rootstown, Ohio, USA
| | - Walter Horne
- Comparative Medicine Unit, Northeast Ohio Medical University, Rootstown, Ohio, USA
| | | | - Phillip McClellan
- Department of Urology, Case Western Reserve University, Cleveland, Ohio, USA
| | - Gregory T MacLennan
- Department of Pathology, Case Western Reserve University, Cleveland, Ohio, USA
| | - Ozan Akkus
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University, Cleveland, Ohio, USA
| | - Adonis Hijaz
- Department of Urology, Case Western Reserve University, Cleveland, Ohio, USA
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Sun X, Zhu H, Li W, Zhao L, Li W, Li X, Xie Z. Small extracellular vesicles secreted by vaginal fibroblasts exert inhibitory effect in female stress urinary incontinence through regulating the function of fibroblasts. PLoS One 2021; 16:e0249977. [PMID: 33836021 PMCID: PMC8034718 DOI: 10.1371/journal.pone.0249977] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 03/28/2021] [Indexed: 01/05/2023] Open
Abstract
Stress urinary incontinence (SUI) is a common condition in women and associated with extra-cellular matrix (ECM) reconstruction, which is mainly regulated by fibroblasts. However, the underlying mechanism remains obscure. Small extracellular vesicles (sEVs) play fundamental biological roles in various cellular functions. Some studies suggested that the sEVs were involved in the metabolism of ECM and the function of fibroblasts. The purpose of our study was to investigate the effect of sEVs secreted by vaginal fibroblasts on the pathogenesis of SUI. We showed that the fibroblasts of female anterior vaginal wall secreted sEVs. Moreover, fibroblasts of females with SUI had significantly elevated secretion of sEVs. The collagen contents, proliferation and migration capacity of fibroblasts were decreased when fibroblasts were co-cultured with fibroblasts-derived sEVs (fibroblast-sEVs) from SUI patients. Proteomic analysis revealed that fibroblast-sEVs contained various differentially expressed proteins including TIMP2, TGF-β and ABCC4, which were involved in signaling pathways of fibroblasts regulation. Therefore, we suggested that fibroblast-sEVs contributed to the pathogenesis of SUI through various proteins including TIMP2, TGF-β and ABCC4.
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Affiliation(s)
- Xiaoyan Sun
- Department of Gynecology, Women’s Hospital School of Medicine Zhejiang University, Hangzhou, Zhejiang, P.R. China
| | - Huimin Zhu
- Department of Gynecology, Women’s Hospital School of Medicine Zhejiang University, Hangzhou, Zhejiang, P.R. China
| | - Wenjuan Li
- Department of Gynecology, Women’s Hospital School of Medicine Zhejiang University, Hangzhou, Zhejiang, P.R. China
| | - Li Zhao
- Department of Gynecology, Women’s Hospital School of Medicine Zhejiang University, Hangzhou, Zhejiang, P.R. China
| | - Wenhua Li
- Department of Gynecology, Women’s Hospital School of Medicine Zhejiang University, Hangzhou, Zhejiang, P.R. China
| | - Xiaoyong Li
- Department of Gynecology, Women’s Hospital School of Medicine Zhejiang University, Hangzhou, Zhejiang, P.R. China
| | - Zhenwei Xie
- Department of Gynecology, Women’s Hospital School of Medicine Zhejiang University, Hangzhou, Zhejiang, P.R. China
- * E-mail:
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Kavallaris A, Zygouris D. Laparoscopic sacrocolpopexy comparing polypropylene mesh with polyvinylidene fluoride mesh for pelvic organ prolapse: Technique description and long term outcomes. Neurourol Urodyn 2020; 39:2264-2271. [PMID: 32776608 DOI: 10.1002/nau.24480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 07/29/2020] [Accepted: 07/29/2020] [Indexed: 11/08/2022]
Abstract
AIM Our aim was to evaluate the feasibility and safety of laparoscopic sacrocolpopexy (LSCP) and compare the long-term outcomes and complication rates of polypropelene (PP) and polyvinylidene fluoride (PVDF), following up within a minimum of 12 months. METHODS This was a retrospective cohort study using patients who underwent LSCP for POP involving either PP or PVDF mesh between January 2011 and January 2018. RESULTS Our study focused on 172 women who underwent LSCP with mesh between January 2011 and January 2018. All procedures were successfully completed laparoscopically, and patients' baseline characteristics were not statistically different in the two groups. Between January 2011 and December 2014, we performed 82 cases of LSC, mainly using PP mesh. Over the last 5 years, since January 2015, we have used PVDF mesh for POP. CONCLUSIONS LSCP using PVDF mesh was found to provide excellent anatomical and functional outcomes after a median follow-up duration of 41 months, compared with the PP group, which had a median follow-up duration of 54 months. Mesh infection and erosion rates in the PP group were significantly higher than those in the PVDF group. Additionally, rates of vaginal pain and discomfort were significantly lower in the PVDF group when compared with the PP group.
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Affiliation(s)
- Andreas Kavallaris
- Department of Minimally Invasive Gynecology, St. Luke's Hospital, Thessaloniki, Greece.,Department of Gynecology and Obstetrics, Mother and Child Medical Center, Nikosia, Cyprus
| | - Dimitrios Zygouris
- Department of Minimally Invasive Gynecology, St. Luke's Hospital, Thessaloniki, Greece
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Powers SA, Burleson LK, Hannan JL. Managing female pelvic floor disorders: a medical device review and appraisal. Interface Focus 2019; 9:20190014. [PMID: 31263534 DOI: 10.1098/rsfs.2019.0014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/07/2019] [Indexed: 02/07/2023] Open
Abstract
Pelvic floor disorders (PFDs) will affect most women during their lifetime. Sequelae such as pelvic organ prolapse, stress urinary incontinence, chronic pain and dyspareunia significantly impact overall quality of life. Interventions to manage or eliminate symptoms from PFDs aim to restore support of the pelvic floor. Pessaries have been used to mechanically counteract PFDs for thousands of years, but do not offer a cure. By contrast, surgically implanted grafts or mesh offer patients a more permanent resolution but have been in wide use within the pelvis for less than 30 years. In this perspective review, we provide an overview of the main theories underpinning PFD pathogenesis and the animal models used to investigate it. We highlight the clinical outcomes of mesh and grafts before exploring studies performed to elucidate tissue level effects and bioengineering considerations. Considering recent turmoil surrounding transvaginal mesh, the role of pessaries, an impermanent method, is examined as a means to address patients with PFDs.
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Affiliation(s)
- Shelby A Powers
- Department of Physiology, Brody School of Medicine, East Carolina University, 600 Moye Boulevard, Mailstop 634, Greenville, NC 27834-4354, USA
| | - Lindsey K Burleson
- Department of Physiology, Brody School of Medicine, East Carolina University, 600 Moye Boulevard, Mailstop 634, Greenville, NC 27834-4354, USA
| | - Johanna L Hannan
- Department of Physiology, Brody School of Medicine, East Carolina University, 600 Moye Boulevard, Mailstop 634, Greenville, NC 27834-4354, USA
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Badlani GH. Re: Patient Safety in Vaginal Mesh Surgery. Eur Urol 2018; 75:533. [PMID: 30578118 DOI: 10.1016/j.eururo.2018.12.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 12/12/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Gopal H Badlani
- Department of Urology, Wake Forest School of Medicine, Winston-Salem, NC, USA.
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Li Q, Li B, Liu C, Wang L, Tang J, Hong L. Protective role of Nrf2 against mechanical-stretch-induced apoptosis in mouse fibroblasts: a potential therapeutic target of mechanical-trauma-induced stress urinary incontinence. Int Urogynecol J 2018; 29:1469-1477. [DOI: 10.1007/s00192-017-3545-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 12/12/2017] [Indexed: 02/06/2023]
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Balsamo R, Illiano E, Zucchi A, Natale F, Carbone A, Sio MD, Costantini E. Sacrocolpopexy with polyvinylidene fluoride mesh for pelvic organ prolapse: Mid term comparative outcomes with polypropylene mesh. Eur J Obstet Gynecol Reprod Biol 2018; 220:74-78. [DOI: 10.1016/j.ejogrb.2017.11.018] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2017] [Revised: 11/12/2017] [Accepted: 11/20/2017] [Indexed: 10/18/2022]
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Thomas D, Demetres M, Anger JT, Chughtai B. Histologic Inflammatory Response to Transvaginal Polypropylene Mesh: A Systematic Review. Urology 2018; 111:11-22. [DOI: 10.1016/j.urology.2017.08.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 07/31/2017] [Accepted: 08/05/2017] [Indexed: 10/19/2022]
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Saunders K. Recent Advances in Understanding Pelvic-Floor Tissue of Women With and Without Pelvic Organ Prolapse: Considerations for Physical Therapists. Phys Ther 2017; 97:455-463. [PMID: 28339839 DOI: 10.1093/ptj/pzx019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 11/13/2016] [Indexed: 11/12/2022]
Abstract
Pelvic organ prolapse is a fairly common condition that imposes significant symptoms, diminished quality of life, social burden, financial expense, and surgical risk on women. As evidence supporting the benefit of pelvic-floor muscle training in nonsurgical management of pelvic organ prolapse grows, physical therapists are becoming a provider of choice interacting with women affected by pelvic organ prolapse. This perspective article will review recent research on tissue characteristics of 3 key components of pelvic organ support: skeletal muscle, ligament, and vaginal wall. This information will be summarized as implications for physical therapists. An improved understanding of pelvic-floor tissue in women with and without pelvic organ prolapse will provide a more comprehensive appreciation of the interaction of multiple systems in the disorder.
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