Mechanical properties of synthetic implants used in the repair of prolapse and urinary incontinence in women: which is the ideal material?

Abstract

The authors review the literature concerning all types of synthetics implants used in prolapse repair or the treatment of stress urinary incontinence, and analyze the mechanical properties of and the tolerance to the various products used. Various synthetic implants are also studied, including their advantages and disadvantages, as well as outcome following implantation and tolerance by the host, with respect to the type of product and the type of intervention. A review of current implant products demonstrated that the perfect product does not exist at present. The most promising of theses products for applications in transvaginal surgery to restore pelvic function appears to be the synthetic prostheses made predominantly of polypropylene, which offer mechanical properties of durability and elasticity. Their properties of resistance are undisputed, but it remains to be shown whether they are well tolerated when inserted by the vaginal route. The technical modalities for their use are still under evaluation, which should enable a better identification of the respective indications for these products in prolapse repair and treatment of urinary incontinence by the vaginal route.

Sexual function in women before and after transvaginal mesh repair for pelvic organ prolapse

“…At the beginning of our experience, the prosthetic meshes used were made of polyester (Parietex ® , Sofradim, Trevoux, France). Due to subsequently published data reporting an increased risk of erosion and infection with polyester meshes [17,18], we first used multifilament polypropylene meshes (Surgipro Mesh®, Tyco Healthcare, Plaisir, France) and then later low-weight monofilament polypropylene (Ugytex ® , Sofradim, Trevoux, France). An elongated Emmet needle was specially manufactured for performing the posterior intravaginal slingplasty (SF50310, SO.D.I.A.M, Montivilliers, France).…”

A fibrinogen-based precision microporous scaffold for tissue engineering

“…[2] Numerous materials have been evaluated for their ability to support blood vessel ingrowth. [3,4] Most synthetic materials effectively inhibit angiogenesis unless impregnated with growth factors, however, some natural proteins have been shown to support vascular growth through the release of their degradation products. Fibrin is one of those materials.…”

Robotic Sacrocolpopexy and Sacrocervicopexy for the Correction of Pelvic Organ Prolapse

“…Several synthetic graft materials have been used historically including expanded PTFE and polyester, with polypropylene being the dominant synthetic used in contemporary kits due its macroporous nature, allowing for tissue in-growth and minimal inflammatory response. [19,20] Commercial kits, designed to allow for minimally invasive mesh insertion, include Elevate (American Medical Systems, Minnetonka, MN, USA) and Gynecare Prolift System (Ethicon Women's Health and Urology, Somerville, NJ, USA), along with several other products and approaches for mesh support of the vaginal apex. In a review of clinical trials and observational studies addressing apical prolapse repair, Diwadkar and colleagues included 3,425 patients from 24 studies employing vaginal mesh kits, reporting a low rate of reoperation for recurrent POP (1.3 % at 17 months), with an overall complication rate (14.5 %) similar to traditional vaginal (15.3 %) and abdominal (17.1%) approaches.…”