The scientific basis for the use of biomaterials in stress urinary incontinence (SUI) and pelvic organ prolapse (POP)

Abstract

Objectives To review the scientific and clinical literature to assess the basis for the use of biomaterials in stress urinary incontinence (SUI) and pelvic organ prolapse (POP). Pelvic floor diseases (PFDS), such as SUI and POP, are common and vexing disorders. While synthetic mesh‐based repairs have long been considered an option for PFD treatment, and their efficacy established in randomised clinical trials, safety of its use has recently been called into question. Materials and Methods Using the PubMed, MEDLINE and Medical Subject Headings (MeSH) databases, we performed a critical review of English‐language publications that contained the following keywords: ‘pelvic organ prolapse’, ‘stress urinary incontinence’, ‘mesh’, ‘biomaterial’, ‘collagen’, ‘elastin’ and ‘extracellular matrix’. After reviewing for relevance for mesh use in the pelvis by two independent reviewers with a third available in the case of disagreement, a total of 60 articles were included in the present review. Results We found that many of the potential causes of PFDs are due to altered metabolism of patient extracellular matrix (specifically collagen, elastin, and their respective enzymes) and as such, repairs using native tissue may suffer from the same abnormalities leading to a subsequent lack of repair integrity. However, mesh use is not without its unique risks. Several publications have suggested that biomaterials may undergo alteration after implantation, but these findings have not been demonstrated in the normal milieu. Conclusion While the decision for the use of synthetic mesh is scientifically sound, its benefits and risks must be discussed with the patient in an informed decision‐making process.

Laparoscopic sacrocolpopexy comparing polypropylene mesh with polyvinylidene fluoride mesh for pelvic organ prolapse: Technique description and long term outcomes

“…19 The laparoconversion rate ranged from 2% to 8% in various studies. 11,20,21 Our study observed no conversion to laparotomy, which we attribute to preoperative bowel preparation and high surgical competence. All operations were performed by the same surgical team with extensive experience in laparoscopic gynecology, who had already performed more than 50 procedures in previous hospital positions.…”

“…The laparoconversion rate ranged from 2% to 8% in various studies 11,20,21 . Our study observed no conversion to laparotomy, which we attribute to preoperative bowel preparation and high surgical competence.…”

Managing female pelvic floor disorders: a medical device review and appraisal

“…Petros's integral theory/system [7][8][9][10] proposes that the shared origin of PFDs does not originate at the musculature, but instead with the loss of connective tissue integrity due to the same repetitive intraabdominal mechanical stresses highlighted by De Lancey and Ashton-Miller: elevated body mass index, hysterectomy, vaginal birth, increased parity, etc. [7,8]. The result is an increase in vaginal and ligament laxity [9].…”

“…Explanations for the high failure rate of autologous tissue include that some women may not have enough suitable native tissue for a proper repair. Additionally, it is hypothesized that vulnerability to PFDs may be explained by dysfunctional extracellular matrix metabolism that weakens pelvic tissues [7]. If a systemic connective tissue dysfunction leads to PFDs, repairs completed with autologous tissue will have high rates of failure.…”

Síndrome De Hipermobilidade Articular Nos Pacientes Com Disfunções Do Diafragma Da Pelve: Revisão De Literatura

“…Associado aos fatores de risco ligados com a saúde e a vida, estudos recentes propõem um possível componente genético para as disfunções do diafragma da pelve. Embora as consequências moleculares, que codificam geneticamente o pavimento pélvi-co, ainda sejam discutidas, pressupõem-se que o mecanismo seja o efeito que ocorre sobre o metabolismo dentro da matriz extracelular (25) . Na maioria dos estudos aqui apresentados, é possível notar que a incidência e epidemiologia das disfunções do diafragma da pelve são bem definidas.…”