Extracellular Matrix Regenerative Graft Attenuates the Negative Impact of Polypropylene Prolapse Mesh on Vagina in Rhesus Macaque

Abstract

BACKGROUND-The use of wide pore lightweight polypropylene mesh to improve anatomical outcomes in the surgical repair of prolapse has been hampered by mesh complications. One of the prototype prolapse meshes has been found to negatively impact the vagina by inducing a decrease in smooth muscle volume and contractility and the degradation of key structural proteins (collagen and elastin), resulting in vaginal degeneration. Recently, bioscaffolds derived from extracellular matrix have been used to mediate tissue regeneration and have been widely adopted in tissue engineering applications.

Oestradiol-releasing Biodegradable Mesh Stimulates Collagen Production and Angiogenesis: An Approach to Improving Biomaterial Integration in Pelvic Floor Repair

“…Several assessments of nondegradable polypropylene meshes in dogs [24], sheep [10], rhesus macaque [25], and humans [26] demonstrate sustained chronic inflammation. Biodegradable PLA meshes last intact for at least 1 yr when implanted in rat models [23].…”

Transvaginal surgery using self‐cut mesh for pelvic organ prolapse: 3‐year clinical outcomes

“…Unfortunately, we have not eliminated POP recurrence or reoperation, complications, or the onset of new pelvic floor symptoms. Some investigators are looking for novel graft materials derived from the extracellular matrix that can promote site‐specific functional tissue remodeling without the risk of erosion . Until these novel pathways of prevention and treatment reach patient application, surgeons managing POP should understand the array of options available, and be able to guide their patients’ decision‐making with the available evidence on outcomes and risks.…”

Laparoscopic Rectopexy with Urinary Bladder Xenograft Reinforcement

“…26 Recent analysis of sacrocolpopexy with UBM reinforcement in primates demonstrates preservation of vaginal tissue quality and remodeling into robust fibrous connective tissue. 27 Reoperations and repairs of recurrent rectal prolapses are challenging cases, with higher potential for complications. Mesh erosion or infection remain late complications in rectal prolapse repair, as well as hiatal hernia repair with synthetic mesh, including polytetrafluoroethylene.…”

“…2,4–11 Few complications are believed to occur with biologically derived mesh repairs, although one complication of a sterile abscess after hiatal hernia repair was reported, related to a non-UBM material requiring surgery to resolve. 27 In addition, granulation tissue formation has been documented with biological graft use in pelvic organ prolapse repair. 30 UBM devices include an intact epithelial basement membrane on one surface and a lamina propria layer on the opposite surface; contain multiple types of carbohydrates, collagens, proteins, and other components; and are gradually resorbed after implantation.…”