Tissue engineering: creation of an autogenic collagenous neoligament to cure urinary stress incontinence

Abstract

Dear Editor, I congratulate Boennelycke et al. on an excellent futuristic article [1]. It is disappointing, however, that they did not address collagen deficiency or the first successful formation of collagenous neoligaments using Mersilene tape scaffolds [2]. In 1987–1988, John Papadimitriou and I developed a new surgical principle, a process for creating an artificial collagenous neoligament. It was published as part of the 1990 Integral Theory [2]. I quote: “We postulated that if such a ligament could be created artificially by precisely inserting a removable synthetic tape in the position occupied by the posterior pubourethral ligament, then it could be used for a corrective procedure for the cure of urinary stress incontinence.” The aim was to use, in a positive way, the collagenous tissue reaction from implanted tapes to reinforce damaged pubourethral ligaments. Mersilene tapes were implanted between rectus abdominis and midurethra in 13 canines for periods of 6–12 weeks. Both tape ends were left lying free in the vaginal cavity [2]. A linear deposition of collagen was observed around all implanted tapes, which persisted after the tape was removed (Fig. 1). Macrophages were observed in tape interstices. There was no discomfort, pyrexia, change in appetite, or raised white cell count in the animals [3] or, subsequently, in patients who had the prototype intravaginal sling procedures. Even if some of the methods mentioned by Boennelycke et al. [1] are successful, and it is hoped they will be, there remains the question of where and how to place the cells. There is increasing evidence that maintaining continence and organ position is mechanical and relies on adequately strong anchoring points for directional muscle forces that open and close the urethra/anorectum and support the organs. Meanwhile, the artificial neoligament principle has evolved beyond the midurethral sling. It has been successfully applied to cure pelvic organ prolapse since the end of 2003 using the tissue fixation system (TFS), a tensioned minisling system that not only reinforces damaged ligaments but shortens them