Abstract
Introduction and hypothesisPolypropylene is a material that is commonly used to treat pelvic floor conditions such as pelvic organ prolapse (POP) and stress urinary incontinence (SUI). Owing to the nature of complications experienced by some patients implanted with either incontinence or prolapse meshes, the biocompatibility of polypropylene has recently been questioned. This literature review considers the in vivo response to polypropylene following implantation in animal models. The specific areas explored in this review are material selection, impact of anatomical location, and the structure, weight and size of polypropylene mesh types.MethodsAll relevant abstracts from original articles investigating the host response of mesh in vivo were reviewed. Papers were obtained and categorised into various mesh material types: polypropylene, polypropylene composites, and other synthetic and biologically derived mesh.ResultsPolypropylene mesh fared well in comparison with other material types in terms of host response. It was found that a lightweight, large-pore mesh is the most appropriate structure.ConclusionThe evidence reviewed shows that polypropylene evokes a less inflammatory or similar host response when compared with other materials used in mesh devices.
Highlights
MethodsAll relevant abstracts from original articles investigating the host response of mesh in vivo were reviewed
Introduction and hypothesisPolypropylene is a material that is commonly used to treat pelvic floor conditions such as pelvic organ prolapse (POP) and stress urinary incontinence (SUI)
The rate decreased from 27 % to 10 % for smaller polypropylene mesh when implanted in the vagina of rabbits and analysed after 9 months [58]. This finding was replicated in a sheep model by Manodoro et al, where it was reported that polypropylene mesh, when reduced in area from 50 mm2 to 35 mm2, resulted in a decrease in erosion rate from 30 % to 0 % when implanted in the vagina [81]
Summary
A PubMed search for animal study articles published from January 1990 to September 2015 was conducted using the following search terms: Bmesh^, Btransvaginal^, Bvaginal^, Bpelvic region^, Bpelvic floor^, pelvic organ prolapse^, Bs tressurinaryincontinence ^, Bp olypropylene ^, Bbi om at er ia l ^, Bt oxicology ^, Bbi ol o g i c al sa f e t y ^, Bbiocompatibility^, Bin vivo^, Banimal model^, Bhost response^. The authors found that when a type III mesh was implanted into the abdominal wall of rats for 3 months the resultant inflammatory and fibrous reactions were more pronounced and persistent compared with those of type I mesh [78] This is thought to be due to the interstices created in multifilament constructs, which is an important consideration because, as already discussed, small pores are thought to increase the likelihood of bacteria being inaccessible to immunocompetent cells. This finding was replicated in a sheep model by Manodoro et al, where it was reported that polypropylene mesh, when reduced in area from 50 mm to 35 mm, resulted in a decrease in erosion rate from 30 % to 0 % when implanted in the vagina [81] These findings suggest that, all other factors being equal, the amount of material might be directly proportional to the erosion rate, a known complication in the presence of an intense foreign body response [19, 77]. The very high erosion rate reported in the study by Fan et al is not typically observed in humans and this could indicate interspecies differences [22]
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