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A soft elastomer alternative to polypropylene for pelvic organ prolapse repair: a preliminary study

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Abstract

Introduction and hypothesis

We compared the impact of a mesh manufactured from the soft elastomer polydimethylsiloxane (PDMS) to that of a widely used lightweight polypropylene (PP) mesh. To achieve a similar overall device stiffness between meshes, the PDMS mesh was made with more material and therefore was heavier and less porous. We hypothesized that the soft polymer PDMS mesh, despite having more material, would have a similar impact on the vagina as the PP mesh.

Methods

PDMS and PP meshes were implanted onto the vaginas of 20 rabbits via colpopexy. Ten rabbits served as sham. At 12 weeks, mesh-vagina complexes were explanted and assessed for contractile function, histomorphology, total collagen, and glycosaminoglycan content. Outcome measures were compared using one-way ANOVA and Kruskal-Wallis testing with appropriate post-hoc testing.

Results

Relative to sham, vaginal contractility was reduced following the implantation of PP (p = 0.035) but not the softer PDMS (p = 0.495). PP had an overall greater negative impact on total collagen and glycosaminoglycan content, decreasing by 53% (p < 0.001) and 54% (p < 0.001) compared to reductions of 35% (p = 0.004 and p < 0.001) with PDMS. However, there were no significant differences in the contractility, collagen fiber thickness, total collagen, and glycosaminoglycan content between the two meshes.

Conclusions

Despite having a substantially higher weight, PDMS had a similar impact on the vagina compared to a low-weight PP mesh, implicating soft polymers as potential alternatives to PP. The notion that heavyweight meshes are associated with a worse host response is not applicable when comparing across materials.

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References

  1. Barber MD, Brubaker L, Burgio KL, Richter HE, Nygaard I, Weidner AC, Menefee SA, Lukacz ES, Norton P, Schaffer J, Nguyen JN, Borello-France D, Goode PS, Jakus-Waldman S, Spino C, Warren LK, Gantz MG, Meikle SF. Comparison of 2 transvaginal surgical approaches and perioperative behavioral therapy for apical vaginal prolapse: the OPTIMAL randomized trial. JAMA J Am Med Assoc. 2014;311(10):1023–34. https://doi.org/10.1001/jama.2014.1719.

    Article  CAS  Google Scholar 

  2. Jelovsek JE, Barber MD, Norton P, Brubaker L, Gantz M, Richter HE, Weidner A, Menefee S, Schaffer J, Pugh N, Meikle S. Effect of uterosacral ligament suspension vs sacrospinous ligament fixation with or without perioperative behavioral therapy for pelvic organ vaginal prolapse on surgical outcomes and prolapse symptoms at 5 years in the OPTIMAL randomized clinical trial. JAMA J Am Med Assoc. 2018;319(15):1554–65. https://doi.org/10.1001/jama.2018.2827.

    Article  Google Scholar 

  3. FDA. Urogynecologic surgical mesh: update on the safety and effectiveness of transvaginal placement for pelvic organ prolapse. 2011.

  4. Nygaard I, Brubaker L, Zyczynski HM, Cundiff G, Richter H, Gantz M, Fine P, Menefee S, Ridgeway B, Visco A, Warren LK, Zhang M, Meikle S. Long-term outcomes following abdominal sacrocolpopexy for pelvic organ prolapse. Jama. 2013;309(19):2016–24. https://doi.org/10.1001/jama.2013.4919.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Wu JM, Matthews CA, Conover MM, Pate V, Jonsson Funk M. Lifetime risk of stress urinary incontinence or pelvic organ prolapse surgery. Obstet Gynecol. 2014;123(6):1201–6.

    Article  Google Scholar 

  6. Greca FH, De Paula JB, Biondo-Simões MLP, Da Costa FD, Da Silva APG, Time S, Mansur A. The influence of differing pore sizes on the biocompatibility of two polypropylene meshes in the repair of abdominal defects: experimental study in dogs. Hernia. 2001;5(2):59–64. https://doi.org/10.1007/s100290100001.

    Article  CAS  PubMed  Google Scholar 

  7. Greca FH, Souza-Filho ZA, Giovanini A, Rubin MR, Kuenzer RF, Reese FB, Araujo LM. The influence of porosity on the integration histology of two polypropylene meshes for the treatment of abdominal wall defects in dogs. Hernia. 2008;12(1):45–9. https://doi.org/10.1007/s10029-007-0276-6.

    Article  CAS  PubMed  Google Scholar 

  8. Klinge U, Klosterhalfen B, Birkenhauer V, Junge K, Conze J, Schumpelick V. Impact of polymer pore size on the interface scar formation in a rat model. J Surg Res. 2002;103(2):208–14.

    Article  CAS  Google Scholar 

  9. Orenstein SB, Saberski ER, Kreutzer DL, Novitsky YW. Comparative analysis of histopathologic effects of synthetic meshes based on material, weight, and pore size in mice. J Surg Res. 2012;176(2):423–9.

    Article  Google Scholar 

  10. Klinge U, Klosterhalfen B, Conze J, Limberg W, Obolenski B, Öttinger AP, Schumpelick V. Modified mesh for hernia repair that is adapted to the physiology of the abdominal wall. Eur J Surg. 1998;164(12):951–60.

    Article  CAS  Google Scholar 

  11. Klinge U, Klosterhalfen B, Muller M, Ottinger AP, Schumpelick V. Shrinking of polypropylene mesh in vivo: an experimental study in dogs. Eur J Surg Acta Chirurgica. 1998;164(12):965–9. https://doi.org/10.1080/110241598750005156.

    Article  CAS  PubMed  Google Scholar 

  12. Klinge U, Junge K, Stumpf M, Öttinger AP, Klosterhalfen B. Functional and morphological evaluation of a low-weight, monofilament polypropylene mesh for hernia repair. J Biomed Mater Res. 2002;63(2):129–36. https://doi.org/10.1002/jbm.10119.

    Article  CAS  PubMed  Google Scholar 

  13. Goh JTW. Biomechanical properties of prolapsed vaginal tissue in pre- and postmenopausal women. Int Urogynecol J Pelvic Floor Dysfunct. 2002;13(2):76–9.

    Article  CAS  Google Scholar 

  14. Knight KM, Moalli PA, Nolfi A, Palcsey S, Barone WR, Abramowitch SD. Impact of parity on ewe vaginal mechanical properties relative to the nonhuman primate and rodent. Int Urogynecol J Pelvic Floor Dysfunct 2016;1–9. https://doi.org/10.1007/s00192-016-2963-2.

  15. Lei L, Song Y, Chen R. Biomechanical properties of prolapsed vaginal tissue in pre- and postmenopausal women. Int Urogynecol J Pelvic Floor Dysfunct. 2007;18(6):603–7. https://doi.org/10.1007/s00192-006-0214-7.

    Article  PubMed  Google Scholar 

  16. Feola A, Abramowitch S, Jallah Z, Stein S, Barone W, Palcsey S, Moalli P. Deterioration in biomechanical properties of the vagina following implantation of a high-stiffness prolapse mesh. BJOG Int J Obstetr Gynaecol. 2013;120(2):224–32.

    Article  CAS  Google Scholar 

  17. Jallah Z, Liang R, Feola A, Barone W, Palcsey S, Abramowitch SD, Yoshimura N, Moalli P. The impact of prolapse mesh on vaginal smooth muscle structure and function. BJOG Int J Obstetr Gynaecol. 2016;123(7):1076–85. https://doi.org/10.1111/1471-0528.13514.

    Article  CAS  Google Scholar 

  18. Liang R, Abramowitch S, Knight K, Palcsey S, Nolfi A, Feola A, Stein S, Moalli PA. Vaginal degeneration following implantation of synthetic mesh with increased stiffness. BJOG Int J Obstetr Gynaecol. 2013;120(2):233–43.

    Article  CAS  Google Scholar 

  19. Knight KM, Artsen AM, Routzong MR, King GE, Abramowitch SD, Moalli PA. New Zealand white rabbit: a novel model for prolapse mesh implantation via a lumbar colpopexy. Int Urogynecol J. 2020;31(1):91–9. https://doi.org/10.1007/s00192-019-04071-z.

    Article  PubMed  Google Scholar 

  20. Neuman RE, Logan MA. The determination of hydroxyproline. J Biol Chem. 1950;184(1):299–306.

    Article  CAS  Google Scholar 

  21. Bhana B, Iyer RK, Chen WLK, Zhao R, Sider KL, Likhitpanichkul M, Simmons CA, Radisic M. Influence of substrate stiffness on the phenotype of heart cells. Biotechnol Bioeng. 2010;105(6):1148–60. https://doi.org/10.1002/bit.22647.

    Article  CAS  PubMed  Google Scholar 

  22. Engler AJ, Carag-Krieger C, Johnson CP, Raab M, Tang HY, Speicher DW, Sanger JW, Sanger JM, Discher DE. Embryonic cardiomyocytes beat best on a matrix with heart-like elasticity: scar-like rigidity inhibits beating. J Cell Sci. 2008;121(22):3794–802. https://doi.org/10.1242/jcs.029678.

    Article  CAS  PubMed  Google Scholar 

  23. Blakney AK, Swartzlander MD, Bryant SJ. Student award winner in the undergraduate category for the society of biomaterials 9th world biomaterials congress, Chengdu, China, June 1-5, 2012: the effects of substrate stiffness on the in vitro activation of macrophages and in vivo host response to poly(ethylene glycol)-based hydrogels. J Biomed Mater Res Part A. 2012;100 A(6):1375–86. https://doi.org/10.1002/jbm.a.34104.

    Article  CAS  Google Scholar 

  24. Brown BN, Mani D, Nolfi AL, Liang R, Abramowitch SD, Moalli PA. Characterization of the host inflammatory response following implantation of prolapse mesh in rhesus macaque. Am J Obstet Gynecol. 2015;213(5):668e661–10. https://doi.org/10.1016/j.ajog.2015.08.002.

    Article  CAS  Google Scholar 

  25. Shepherd JP, Feola AJ, Abramowitch SD, Moalli PA. Uniaxial biomechanical properties of seven different vaginally implanted meshes for pelvic organ prolapse. Int Urogynecol J Pelvic Floor Dysfunct. 2012;23(5):613–20.

    Article  Google Scholar 

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Acknowledgements

The authors are grateful for the financial support provided the Department of Defense (DOD) (grant no. W81XWH-16-1-0133). The DOD did not provide any assistance with the study design, the collection, analysis and interpretation of data or in the writing of this report or in the decision to submit the article for publication. Research efforts for this publication was also supported by the National Center for Advancing Translational Sciences of the National Institutes of Health under award no. TL1TR001858. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The authors would also like to thank Dr. Naoki Yoshimura, MD PhD (Professor of Urology, Pharmacology, and Cell Biology, University of Pittsburgh), for allowing us to use the organ bath system to collect the contractility data reported, Dr. Leslie Meyn (Magee-Womens Research Institute) for statistical assistance, and Jannah Mujaahid for her assistance with animal care and imaging. The code used to image the picrosirius red images was written by Christopher A. Carruthers (PhD graduate of the University of Pittsburgh, Bioengineering Department).

Authors’ contributions

• KM Knight: Manuscript writing/editing, experimentation, data collection, and analysis, project development.

• GE King: Manuscript editing, experimentation, data collection, and analysis.

• SL Palcsey: Manuscript editing, experimentation.

• AM Artsen: Manuscript editing, experimentation.

• SD Abramowitch: Manuscript writing/editing, project/concept development.

• PA Moalli: Manuscript writing/editing, experimentation, project/concept development.

Funding

Financial support was provided by the Department of Defense (DOD) (W81XWH-16-1-0133) and the National Center for Advancing Translational Sciences of the National Institutes of Health (NIH) (TL1 TR001858).

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Authors and Affiliations

  1. Department of Obstetrics, Gynecology & Reproductive Sciences, University of Pittsburgh, Pittsburgh, PA, USA

    Katrina M. Knight, Amanda M. Artsen, Steven D. Abramowitch & Pamela A. Moalli

  2. Magee-Womens Research Institute, 204 Craft Avenue, Lab A320, Pittsburgh, PA, 15213, USA

    Katrina M. Knight, Gabrielle E. King & Stacy L. Palcsey

  3. Division of Urogynecology & Pelvic Reconstructive Surgery, UPMC Magee-Womens Hospital, Pittsburgh, PA, USA

    Amanda M. Artsen & Pamela A. Moalli

  4. Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA

    Steven D. Abramowitch & Pamela A. Moalli

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  1. Katrina M. Knight
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Correspondence to Katrina M. Knight.

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American Urogynecology Society/International Urogynecological Association Joint Scientific Meeting, Nashville, Tennessee, September 24–28, 2019

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Knight, K.M., King, G.E., Palcsey, S.L. et al. A soft elastomer alternative to polypropylene for pelvic organ prolapse repair: a preliminary study. Int Urogynecol J 33, 327–335 (2022). https://doi.org/10.1007/s00192-021-04792-0

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  • DOI: https://doi.org/10.1007/s00192-021-04792-0

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