title: Evaluating Alternative Materials for the Treatment of Stress Urinary Incontinence and Pelvic Organ Prolapse: A Comparison of the In Vivo Response to Meshes Implanted in Rabbits.
abstract: Serious complications can develop with the mesh implants used for stress urinary incontinence and pelvic organ prolapse surgery. We evaluated 2 materials currently in clinical use and 2 alternative materials using a rabbit abdominal model to assess host response and biomechanical properties of the materials before and after implantation.
  
  
  
  Poly-L-lactic acid and polyurethane meshes were electrospun to be compared to commercially available polypropylene and polyvinylidene fluoride meshes. A total of 40 immunocompetent full-thickness abdominal wall defect rabbit models were used, including 8 in each of the poly-L-lactic acid, polyurethane, polyvinylidene fluoride and polypropylene experimental groups, and sham controls. Two 20 mm defects were created per animal and primarily repaired. The experimental groups then underwent onlay of each repair material while sham controls did not. Four rabbits per group were sacrificed at days 30 and 90. Abdominal wall specimens containing the defect with or without repair material were explanted to be assessed by histology (hematoxylin and eosin staining, and immunohistochemistry) and biomechanical testing at 30 and 90 days.
  
  
  
  At 90 days of implantation tissues repaired with all 4 materials showed biomechanical properties without significant differences. However, polypropylene and polyvinylidene fluoride meshes demonstrated a sustained chronic inflammatory response profile by 90 days. In contrast, poly-L-lactic acid and polyurethane meshes integrated well into host tissues with a decreased inflammatory response, indicative of constructive remodeling.
  
  
  
  Poly-L-lactic acid and polyurethane alternative materials achieved better host integration in rabbit models than current synthetic repair materials.
authors.affiliation: Kroto Research Institute, University of Sheffield (SR, CH, NIO, SM), Sheffield, United Kingdom; Royal Hallamshire Hospital (CH, NIO, CRC), Sheffield, United Kingdom; Organ Systems, Department of Development and Regeneration, Katholieke Universiteit Leuven-University of Leuven, Leuven, Belgium; Department of Obstetrics and Gynaecology, University Hospitals Leuven, Leuven (IU, GC, JD), Belgium.
authors.forename: Sabiniano
authors.initials: S
authors.lastname: Roman
authors.affiliation: Kroto Research Institute, University of Sheffield (SR, CH, NIO, SM), Sheffield, United Kingdom; Royal Hallamshire Hospital (CH, NIO, CRC), Sheffield, United Kingdom; Organ Systems, Department of Development and Regeneration, Katholieke Universiteit Leuven-University of Leuven, Leuven, Belgium; Department of Obstetrics and Gynaecology, University Hospitals Leuven, Leuven (IU, GC, JD), Belgium.
authors.forename: Iva
authors.initials: I
authors.lastname: Urbánková
authors.affiliation: Kroto Research Institute, University of Sheffield (SR, CH, NIO, SM), Sheffield, United Kingdom; Royal Hallamshire Hospital (CH, NIO, CRC), Sheffield, United Kingdom; Organ Systems, Department of Development and Regeneration, Katholieke Universiteit Leuven-University of Leuven, Leuven, Belgium; Department of Obstetrics and Gynaecology, University Hospitals Leuven, Leuven (IU, GC, JD), Belgium.
authors.forename: Geertje
authors.initials: G
authors.lastname: Callewaert
authors.affiliation: Kroto Research Institute, University of Sheffield (SR, CH, NIO, SM), Sheffield, United Kingdom; Royal Hallamshire Hospital (CH, NIO, CRC), Sheffield, United Kingdom; Organ Systems, Department of Development and Regeneration, Katholieke Universiteit Leuven-University of Leuven, Leuven, Belgium; Department of Obstetrics and Gynaecology, University Hospitals Leuven, Leuven (IU, GC, JD), Belgium.
authors.forename: Flore
authors.initials: F
authors.lastname: Lesage
authors.affiliation: Kroto Research Institute, University of Sheffield (SR, CH, NIO, SM), Sheffield, United Kingdom; Royal Hallamshire Hospital (CH, NIO, CRC), Sheffield, United Kingdom; Organ Systems, Department of Development and Regeneration, Katholieke Universiteit Leuven-University of Leuven, Leuven, Belgium; Department of Obstetrics and Gynaecology, University Hospitals Leuven, Leuven (IU, GC, JD), Belgium.
authors.forename: Christopher
authors.initials: C
authors.lastname: Hillary
authors.affiliation: Kroto Research Institute, University of Sheffield (SR, CH, NIO, SM), Sheffield, United Kingdom; Royal Hallamshire Hospital (CH, NIO, CRC), Sheffield, United Kingdom; Organ Systems, Department of Development and Regeneration, Katholieke Universiteit Leuven-University of Leuven, Leuven, Belgium; Department of Obstetrics and Gynaecology, University Hospitals Leuven, Leuven (IU, GC, JD), Belgium.
authors.forename: Nadir I
authors.initials: NI
authors.lastname: Osman
authors.affiliation: Kroto Research Institute, University of Sheffield (SR, CH, NIO, SM), Sheffield, United Kingdom; Royal Hallamshire Hospital (CH, NIO, CRC), Sheffield, United Kingdom; Organ Systems, Department of Development and Regeneration, Katholieke Universiteit Leuven-University of Leuven, Leuven, Belgium; Department of Obstetrics and Gynaecology, University Hospitals Leuven, Leuven (IU, GC, JD), Belgium.
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Chapple
authors.affiliation: Kroto Research Institute, University of Sheffield (SR, CH, NIO, SM), Sheffield, United Kingdom; Royal Hallamshire Hospital (CH, NIO, CRC), Sheffield, United Kingdom; Organ Systems, Department of Development and Regeneration, Katholieke Universiteit Leuven-University of Leuven, Leuven, Belgium; Department of Obstetrics and Gynaecology, University Hospitals Leuven, Leuven (IU, GC, JD), Belgium.
authors.forename: Jan
authors.initials: J
authors.lastname: Deprest
authors.affiliation: Kroto Research Institute, University of Sheffield (SR, CH, NIO, SM), Sheffield, United Kingdom; Royal Hallamshire Hospital (CH, NIO, CRC), Sheffield, United Kingdom; Organ Systems, Department of Development and Regeneration, Katholieke Universiteit Leuven-University of Leuven, Leuven, Belgium; Department of Obstetrics and Gynaecology, University Hospitals Leuven, Leuven (IU, GC, JD), Belgium. Electronic address: s.macneil@sheffield.ac.uk.
authors.forename: Sheila
authors.initials: S
authors.lastname: MacNeil
mesh_terms: D000818:Animals; D001696:Biomechanical Phenomena; D008297:Male; D008422:Materials Testing; D008855:Microscopy, Electron, Scanning; D056887:Pelvic Organ Prolapse / Q000601:surgery*; D011091:Polyesters; D011126:Polypropylenes; D011140:Polyurethanes; D011145:Polyvinyls; D019919:Prosthesis Implantation / Q000295:instrumentation*; D011817:Rabbits; D013526:Surgical Mesh; D014550:Urinary Incontinence, Stress / Q000601:surgery*; D005465:Fluorocarbon Polymers
chemical_list: D011091:Polyesters; D011126:Polypropylenes; D011140:Polyurethanes; D011145:Polyvinyls; C024865:polyvinylidene fluoride; D005465:Fluorocarbon Polymers; C033616:poly(lactide)
keywords: foreign-body reaction; pelvic organ prolapse; surgical mesh; urinary bladder; urinary incontinence, stress