Abstract
ABSTRACTPurpose:Despite high success rates in the treatment of urinary incontinence, complications related to the use of polypropylene (PP) meshes are still a concern, especially in vaginal prolapses surgeries. The objective of this study was to assess the effect of autologous platelet-rich plasma (PRP) coating on the integration of PP meshes implanted in the vaginal submucosa of rabbits.Materials and Methods:Thirty adult New Zealand rabbits were randomly divided into two groups (n=15): PP, implanted with conventional PP meshes; and PRP, implanted with autologous PRP coated PP meshes. Animals in both groups (n=5) were euthanized at 7, 30 and 90 days postoperatively, the vaginas extracted and sent to immunohistochemical analysis for the assessment of the pro-inflammatory agent TNF-α, anti-inflammatory agents TGF-β and IL-13, collagen metabolism marker MMP-2, and angiogenesis marker CD-31. AxioVision™ image analysis was used for the calculation of the immunoreactive area and density. Statistical analysis was performed with ANOVA followed by Tukey test (p <0.05).Results:Animals in the PRP group showed significantly increased expression of the angiogenesis agent CD-31 at all experimental times when compared to the PP group (p <0.0001). However, no differences concerning the expression of the other markers were observed between the groups.Conclusion:The addition of autologous PRP gel to PP meshes can be simply and safely achieved and seems to have a positive effect on implantation site angiogenesis. Further investigations are required to ascertain PPR coated meshes clinical efficacy in prolapses and stress urinary incontinence surgeries.
Highlights
With the rapid aging of the world’s population, pelvic organ prolapses (POP) and stress urinary incontinence (SUI) have become common health problems among women, with serious effects on their health, as well as their personal, sexual, and professional life [1].Polypropylene (PP) meshes have been used for decades, and are considered the gold standard in urogynecology surgeries
After the American Food and Drug Administration (FDA) reported on more than 3500 unexpected and severe adverse events in 2008 and 2011, the transvaginal placement of surgical meshes has become a source of concern worldwide [2]
Sample The sample consisted of thirty white female New Zealand rabbits (Oryctolagus cuniculus), specially bred for research purposes, aged between 3 and 6 months and weighing between 2.5 and 4kg
Summary
Polypropylene (PP) meshes have been used for decades, and are considered the gold standard in urogynecology surgeries. It is a simple technique with higher success rates than traditional tissue self-repair. While many factors may influence complications rates, such as surgeon experience and the correct indication for implantation and dissection techniques, mesh features can represent a determinant factor [3]. There is evidence that changes to mesh surface can influence tissue response in vivo [4]. Several different types of biomaterials have been tested for mesh coating purposes, no consistent results have been reported so far [5]
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