Can platelet-rich plasma coating improve polypropylene mesh integration? An immunohistochemical analysis in rabbits

Abstract

Purpose: Despite high success rates in the treatment of urinary incontinence, complications related to the use of polypropylene (PP) meshes are still a concern, especially in vaginal prolapses surgeries. The objective of this study was to assess the effect of autologous platelet-rich plasma (PRP) coating on the integration of PP meshes implanted in the vaginal submucosa of rabbits. Materials and Methods: Thirty adult New Zealand rabbits were randomly divided into two groups (n=15): PP, implanted with conventional PP meshes; and PRP, implanted with autologous PRP coated PP meshes. Animals in both groups (n=5) were euthanized at 7, 30 and 90 days postoperatively, the vaginas extracted and sent to immunohistochemical analysis for the assessment of the pro-inflammatory agent TNF-α, anti-inflammatory agents TGF-β and IL-13, collagen metabolism marker MMP-2, and angiogenesis marker CD-31. AxioVision™ image analysis was used for the calculation of the immunoreactive area and density. Statistical analysis was performed with ANOVA followed by Tukey test (p <0.05). Results: Animals in the PRP group showed significantly increased expression of the angiogenesis agent CD-31 at all experimental times when compared to the PP group (p <0.0001). However, no differences concerning the expression of the other markers were observed between the groups. Conclusion: The addition of autologous PRP gel to PP meshes can be simply and safely achieved and seems to have a positive effect on implantation site angiogenesis. Further investigations are required to ascertain PPR coated meshes clinical efficacy in prolapses and stress urinary incontinence surgeries.

Platelet rich plasma for the management of urogynecological disorders: the current evidence

“…Up ]. Despite the fact that both groups presented significant morphological variations in muscle spindles compared to rats without SUI, the PRP group had lower variations than the control one [14 ]. The pilot study by Behnia-Wilson et al was the first observational study that investigated the effect of PRP in the management of SUI by applying a combination of PRP and CO 2 micro-ablative laser in 62 patients with SUI [15].…”

“…In the field of mesh surgery, preliminary in vitro and animal studies have also shown encouraging outcomes in improving the postoperative outcomes after the use of meshes coated with PRP [4 ▪▪ ]. The randomized experimental study by Dias et al evaluated the impact of PRP-coated polypropylene meshes compared to noncoated ones implanted in rabbit's vaginal submucosa [22 ▪ ]. A significantly elevated CD-31 angiogenesis marker was observed in favor of PRP group compared to control ( P < 0.0001 ) while inflammatory markers including interluekin-13, TGF-β and TNF-α did not differ among the two groups [22 ▪ ].…”

“…The randomized experimental study by Dias et al evaluated the impact of PRP-coated polypropylene meshes compared to noncoated ones implanted in rabbit's vaginal submucosa [22 ▪ ]. A significantly elevated CD-31 angiogenesis marker was observed in favor of PRP group compared to control ( P < 0.0001 ) while inflammatory markers including interluekin-13, TGF-β and TNF-α did not differ among the two groups [22 ▪ ]. CD-31 is considered a critical marker indicative of neovascularization and enhanced angiogenesis on the mesh implanted area that could potentially predispose to successful implantation outcomes.…”