What material is pelvic mesh & what it’s used for?
Pelvic mesh is widely used to correct transabdominal pelvic organ prolapse (POP). To treat pelvic organ prolapse, transabdominal mesh surgery utilizes a surgical mesh material to support the top of the vagina. The transabdominal prolapse mesh is stitched to the front of the tailbone (sacrum) above the pubic bone. If required, this treatment may be followed by a transvaginal prolapse repair.
Pelvic organ prolapse repair surgery may help relieve persistent pelvic pain caused by prolapse/fallen vagina, pelvic organ problems, bowel movements, or bladder emptying.
Various reasons, including issues with the mesh material, cause transvaginal mesh surgery complications. The evolution of surgical mesh from metal implants to current polymer-based mesh demonstrates that material qualities are the most important predictors of surgical procedure outcomes with surgical mesh repairs.
Today’s article discusses what material is pelvic mesh and used in making transabdominal mesh and their effect on the outcome and success rate of treating pelvic organ prolapse and stress urinary incontinence.
The Basics of Transabdominal Mesh Surgery
Transabdominal mesh is a screen-like material that strengthens tissue or bone during surgical procedures to treat pelvic floor disorders. Both synthetic polymers and biopolymers are materials used to make the mesh. Women with stress incontinence or pelvic organ prolapse (POP) may benefit from synthetic mesh repair.
In cases of pelvic organ prolapse, the pelvic organs may slip down and protrude through the vaginal wall in many women. This happens when a woman’s pelvic floor muscles and tissue are too weak to contain her reproductive organs.
Prolapse may affect the bladder, uterus, rectum, vagina, and urethra, all of which are located in the pelvis. Pregnancy, giving birth, and advanced age are all risk factors for POP in women.
Stress urinary incontinence occurs when the strain on the abdomen increases during certain activities. Among these actions include sneezing, exercising, and coughing. The bladder neck drops due to losing strength in the pelvic muscles and tissues. Pregnancy, delivery, and advanced age are all risk factors for pelvic muscle laxity and weakness, which may lead to prolapsed pelvic organs and stress urinary incontinence.
What material is pelvic mesh made of?
Polypropylene: – Because of its biocompatibility, physical strength, and simplicity of production, polypropylene (PP) remains the dominant material for transabdominal meshes. However, PP surgical mesh devices are still susceptible to problems like mesh displacement and bacterial infection, which may result in mesh failure.
Polyester: Polyester is a carbon-based polymer that is often used in textiles. Polyester meshes offer strong reinforcing but are rigid and less flexible. Although meshes made from polyester are soft and malleable, they are more susceptible to infection. Nonabsorbable meshes have the disadvantage of increasing stiffness over time and the likelihood of prolapse recurrence owing to mesh shrinkage and separation, mesh erosion, and adhesion development.
Meshes made from biological materials are constructed from the intestine or skin of animal tissue that has been sterilized and processed for use to treat pelvic organ prolapse. The body may absorb the biological-based meshes. Usually, bovine (from cows) or porcine (from pigs) tissue is utilized to make animal mesh implants.
Its purpose is to provide the repaired pelvic organ more support for the long haul. Over time, the body will absorb the absorbable mesh, reducing its strength. Mesh made from biological material is not meant to be a permanent solution for reinforcing the patched area after pelvic surgery. New tissue development after the absorption of the mesh is expected to reinforce the healing site.
Composition and Construction of Transabdominal Mesh
Pelvic polypropylene mesh is a flat sheet made by knitting or weaving a PP fiber. Knitted mesh implants are made up of a single filament looped with itself to form the structure, while woven mesh implants are made up of two separate filaments crossed perpendicularly with each other. Knitted mesh is substantially more porous and flexible than woven mesh. As a result, it is the favored technique of production.
Greater flexibility increases the material’s resilience, allowing it to absorb big bursts of energy and bend elastically, allowing it to persist longer in the high-pressure environment of the pelvic cavity: lower mesh load and less native tissue in contact with the PP material result from increased porosity. As a result, the immune response is dampened since less tissue responds to the foreign body PP mesh, lowering the chances of treatment failure and morbidity. The fundamental advantage of the polypropylene mesh over biological alternatives is its resistance to enzyme breakdown.
Material Considerations and Selection
PP mesh is non-toxic, but its physical qualities show a substantial mismatch between its viscoelastic properties and the surrounding tissue, which is a possible source of mesh complications. Furthermore, a lack of integration of PP mesh into surrounding tissue over extended durations of follow-up is a risk factor for permanent problems.
The capacity of a material to operate with an adequate host reaction in a certain application is called biocompatibility. In other words, the implanted mesh should be able to perform its intended job without causing damage to the host.
However, in some cases, the mesh may interact with the patient and cause allergic reactions or serious complications such as inflammation. Most meshes made from synthetic polymers are more inclined to cause reactions.
Challenges and Innovations in Mesh Material Selection
Materials used in making mesh, such as synthetic polymers, have led to adverse effects and mesh-related complications. Women who underwent mesh surgery have had to undergo mesh removal to counteract some of these issues.
The most often documented consequence of pelvic organ prolapse treatment with surgical mesh is mesh erosion, also known as mesh exposure, extrusion, or protrusion. When the mesh erodes through tissue and becomes apparent, this happens. Erosion may be very painful, and vaginal erosion typically makes intercourse painful.
Aside from the vagina, mesh erosion may affect other organs. Urinary tract erosion may result in repeated infections and excruciating pelvic pain. Discomfort, Infections, inflammation, and irregular connections known as fistulas may result from erosion into the bladder and rectum.
Most surgical meshes now in use are chemically and physically inert, nontoxic, stable, and non-immunogenic. In terms of the physiology of abdominal mesh implantation, inflammation, and wound healing are likely to be the most concerning and hence the focus of most studies.
Over the years, surgical mesh implants have progressed from a metal wire mesh to the monofilament, macroporous PPL mesh utilized in modern surgical treatment. The material was improved as a consequence of clinical input, primarily in the context of female pelvic medicine, over a long period of time. Female pelvic reconstructive surgery was also adjusted to use newly available materials to provide the greatest surgical results for patients.
The synthetic mesh failed mechanically and physiologically when applied to pelvic floor surgery. The scientific and surgical communities now have clear evidence that an implant material must be designed and tested for specific clinical applications using relevant animal models, which will then inform legal decision-makers about the need for clinical trials before approval and postmarket surveillance.
Mesh materials for vaginal mesh implants have now been classified as a category III regulatory risk. Any new materials to be assessed in the future will need extensive testing, further extensive examination in relevant animal models, and clinical safety trials.