Biodegradable mesh implants for prolapse repair: Advances in computational modelling and experimental validation

Abstract

Pelvic organ prolapse (POP) limits people’s quality of life and is quite common in women, especially with advancing age. As cases increase, there is an urgent need for alternative treatments, especially for severe POP, where options remain limited. Surgical procedures involving synthetic meshes are associated with several complications, leading to the FDA (Food and Drug Administration) banning the commercialisation of these meshes to treat cases of transvaginal prolapse. Biodegradable meshes offer a potential solution to address the drawbacks associated with synthetic meshes, offering improved biocompatibility and biomechanical properties. This study developed computational models with variations in pore geometry, pore size, filament thickness and the inclusion of filaments in specific regions of the mesh. One of the meshes was then 3D printed to validate the simulation results. Subsequently, a uniaxial tensile test was performed on sow vaginal tissue to compare its mechanical behaviour with the simulations and identify meshes that closely mimic vaginal tissue behaviour. The mesh that most closely replicates vaginal tissue behaviour featured a smaller pore diameter (1.50 mm), filaments placed in specific areas, and variable filament thickness across the mesh. However, when compared to the uterosacral ligament, the meshes did not exhibit similar mechanical properties. Additionally, the commercially available mesh failed to replicate the behaviour of both vaginal tissue and the uterosacral ligament, suggesting it may not be the optimal option for POP repair. Biodegradable meshes, with their customisable properties, show great promise as future solutions for personalised and safer surgical treatment of POP.