Evaluation of xenogenic extracellular matrices as adjuvant scaffolds for the treatment of stress urinary incontinence

Introduction and hypothesis Tissue-engineered biomaterials have shown recent promise as adjuvant scaffolds for treating stress urinary incontinence (SUI). The objective of the present study was to compare their mechanical and regenerative properties with synthetic biomaterials in this urogynaecological setting. Methods The biomechanical properties of polypropylene (Serasis®; n=12), four-ply urinary bladder matrix (UBM; n=12) and four-ply small intestinal submucosa (SIS; n=12) were determined with uni-axial tensile testing protocols and compared with stress-strain curves. Subsequently, human dermal fibroblasts (2.5×104cells/cm2) were cultured onto each biomaterial under conventional laboratory growth conditions for 12 consecutive days. Attachment, viability, and proliferative activity of fibroblasts were evaluated and compared using quantitative viability indicators and scanning electron microscopy. Results There were no significant differences in the biomechanical properties of each biomaterial assessed. Incremental stiffness at 0-10 % strain measured 5.73±0.36 MPa for polypropylene compared with 8.23±0.92MPa and 6.81±0.83 MPa for SIS and UBM respectively (p>0.05). Viability and proliferative activity of fibroblasts differed significantly on all three biomaterials with the luminal and abluminal surfaces of the UBM demonstrating significantly greater rates of fibroblast proliferation compared with polypropylene and SIS (p<0.01). Conclusion This is the first comparative study on porcine UBM, porcine SIS, and synthetic polypropylene as adjuvant scaffolds for the treatment of SUI. Our results demonstrate that porcine UBMmay provide an attractive alternative owing to its superior remodelling potential.