TY - JOUR
T1 - Stress urinary incontinence and pelvic organ prolapse
T2 - Biologic graft materials revisited
AU - Whooley, Jack
AU - Cunnane, Eoghan M.
AU - Do Amaral, Ronaldo
AU - Joyce, Michael
AU - MacCraith, Eoin
AU - Flood, Hugh D.
AU - O'Brien, Fergal J.
AU - Davis, Niall F.
N1 - Publisher Copyright:
© Mary Ann Liebert, Inc.
PY - 2020/10
Y1 - 2020/10
N2 - 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.
AB - 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.
KW - Biomaterials
KW - Mesh
KW - Pelvic organ prolapse
KW - Stress urinary incontinence
KW - Urogynecology
UR - http://www.scopus.com/inward/record.url?scp=85093927515&partnerID=8YFLogxK
U2 - 10.1089/ten.teb.2020.0024
DO - 10.1089/ten.teb.2020.0024
M3 - Review article
C2 - 32192400
AN - SCOPUS:85093927515
SN - 1937-3368
VL - 26
SP - 475
EP - 483
JO - Tissue Engineering - Part B: Reviews
JF - Tissue Engineering - Part B: Reviews
IS - 5
ER -