The use of polymeric meshes for pelvic organ prolapse: Current concepts, challenges, and future perspectives

Abstract

Pelvic organ prolapse (POP) is one of the most common chronic disorders in women, impacting the quality of life of millions of them worldwide. More than 100 surgical procedures have been developed over the decades to treat POP. However, the failure of conservative strategies and the number of patients with recurrence risk have increased the need for further adjuvant treatments. Since their introduction, surgical synthetic meshes have dramatically transformed POP repair showing superior anatomic outcomes in comparison to traditional approaches. Although significant progress has been attained, among the meshes in clinical use, there is no single mesh appropriate for every surgery. Furthermore, due to the risk of complications including acute and chronic infection, mesh shrinkage, and erosion of the tissue, the benefits of the use of meshes have recently been questioned. The aim of this work is to review the evolution of POP surgery, analyzing the current challenges, and detailing the key factors pertinent to the design of new mesh systems. Starting with a description of the pelvic floor anatomy, the article then presents the traditional treatments used in pelvic organ disorders. Next, the development of synthetic meshes is described with an insight into how their function is dependent on both mesh design variables (i.e., material, structure, and functional treatment) and surgical applications. These are then linked to common mesh‐related complications, and an indication of current research aiming to address these issues.

3D Printing of Drug-Loaded Thermoplastic Polyurethane Meshes: A Potential Material for Soft Tissue Reinforcement in Vaginal Surgery

“…PP is the main polymer used for the production of synthetic meshes for POP surgery due to its chemical stability and non-biodegradable property [8]. However, complications such as adhesion to the viscera and high inflammatory response found in the repair of the pelvic floor [8] have led researchers to study alternative solutions.…”

“…PP is the main polymer used for the production of synthetic meshes for POP surgery due to its chemical stability and non-biodegradable property [8]. However, complications such as adhesion to the viscera and high inflammatory response found in the repair of the pelvic floor [8] have led researchers to study alternative solutions. Biodegradable/bioresorbable polymers, such as poly(caprolactone) or poly(lactic acid) (PLA), have been used for mesh implant application with mixed results [9][10][11].…”

Next-generation surgical meshes for drug delivery and tissue engineering applications: materials, design and emerging manufacturing technologies

“…A strong immune reaction could potentially lead to the formation of a fibrotic scar tissue around the implant and to its encapsulation [3,11]. In the case of hernia and PFDs, an excessive production of fibrotic tissue may cause native tissue erosion with the subsequent extrusion (or migration) of the mesh [3,5]. Moreover, the formation of the fibrotic capsule is often linked to a reduction of the available mesh area, also known as mesh contraction [5,62].…”

“…Meshes for hernia repair applications provided a tension-free reinforcement for the injured tissue [4] that resulted in better outcomes both in terms of tissue integration and consequent repair [3]. Having noticed the improvements reported in the treatment of hernia, in 1970s meshes were introduced for the management of pelvic floor dysfunctions (PFDs), including pelvic organ prolapse (POP) and stress urinary incontinence (SUI), with the first urogynaecological mesh approved by the US Food and Drug Administration (FDA) only 20 years ago [5].…”

“…They have been developed as an alternative to biological prostheses, aiming to overcome the limitations related to their use, such as the possibility to develop infections, unpredictable mechanical properties and the high risk associated with tissue harvesting procedures [3,5]. However, their employment is also linked to a vast number of post-operative complications, with infection the most common one in hernia [3], PFDs [5], GBR [7] and breast reconstruction (BR) [10]. Other complications include the arising of chronic immune reaction and subsequent fibrotic process [11] and device mechanical failure.…”