Stress urinary incontinence and pelvic organ prolapse: Biologic graft materials revisited

Jack Whooley, Eoghan M. Cunnane, Ronaldo Do Amaral, Michael Joyce, Eoin MacCraith, Hugh D. Flood, Fergal J. O'Brien, Niall F. Davis

Research output: Contribution to journalReview articlepeer-review

Abstract

Symptomatic stress urinary incontinence (SUI) and pelvic organ prolapse (POP) refractory to conservative management with pelvic floor muscle training or vaginal pessaries may warrant surgical intervention with different forms of biologic or synthetic material. However, in recent years, several global regulatory agencies have issued health warnings and recalled several mesh products due to an increase in complications such as mesh erosion, infection, chronic pain, and perioperative bleeding. At present, current surgical treatment strategies for SUI and POP are aimed at developing biological graft materials with similar mechanical properties to established synthetic meshes, but with improved tissue integration and minimal host response. This narrative review aims to highlight recent studies related to the development of biomimetic and biologic graft materials as alternatives to traditional synthetic materials for SUI/POP repair in female patients. We also investigate complications and technical limitations associated with synthetic mesh and biological biomaterials in conventional SUI and POP surgery. Our findings demonstrate that newly developed biologic grafts have a lower incidence of adverse events compared to synthetic biomaterials. However there remains a significant disparity between success in preclinical trials and long-term clinical translation. Further characterization on the optimal structural, integrative, and mechanical properties of biological grafts is required before they can be reliably introduced into clinical practice for SUI and POP surgery.

Original languageEnglish
Pages (from-to)475-483
Number of pages9
JournalTissue Engineering - Part B: Reviews
Volume26
Issue number5
DOIs
Publication statusPublished - Oct 2020
Externally publishedYes

Keywords

  • Biomaterials
  • Mesh
  • Pelvic organ prolapse
  • Stress urinary incontinence
  • Urogynecology

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