Operating theatre

New material could offer alternative to controversial vaginal mesh

Image credit: Dremstime

Researchers at the University of Sheffield have developed a new tissue-like material which could provide an alternative to current vaginal mesh, releasing oestrogen to assist with healing.

Many women undergo vaginal mesh implants in order to combat pelvic organ prolapses and urinary stress incontinence; these conditions affect up to half of postmenopausal women, but are considered embarrassing.

The insertion of a polypropylene mesh inside the vagina is intended to give permanent support to weakened organs, as tissue grows into the pores of the mesh.

Recently, women around the world have pushed to raise awareness of the life-changing complications associated with this mesh, including chronic inflammation, which results in scar tissue formation and severe pain. In some cases this prevents women from socialising, and renders penetrative sex agonising.

A consumer survey of 2,220 Australian women who had vaginal mesh implanted found that 59 per cent did not have their original complaint resolved by the operation, and 58 per cent suffered pain during sex.

Approximately 19 per cent of women who have had vaginal mesh inserted have had to have a second procedure, sometimes to have the mesh removed altogether.

Legal action has been taken regarding polypropylene mesh in the US and in the UK, where more than 800 women are suing the NHS and mesh manufacturers. Professor Carl Heneghan, a University of Oxford academic specialising in evidence-based medicine, stated that vaginal mesh could be a scandal worse than Thalidomide. Polypropylene vaginal mesh is banned in Australia.

“For many years now, surgeons have been treating the problems of urinary stress incontinence and pelvis organ prolapse using the only synthetic material they had to hand: polypropylene,” said Professor Sheila MacNeil, a tissue engineering expert. “In certain procedures, for example, when the polypropylene mesh is used as a thin strip to support the urethra and reduce the symptoms of stress incontinence, the results show it is beneficial to the patient and carries relatively little risk.

“However, when much bigger areas of the same material are inserted through the vagina to relieve pelvic organ prolapse, the complication rate is frankly unacceptable. Surgeons who are experts in this area have concluded that there is a need for a new synthetic material that is better suited for use in the pelvic floor.

“We started our research because it was clear that the polypropylene mesh was not fit for use in the pelvic floor,” she said.

Over seven years of research, MacNeil and her team at Sheffield’s Department of Material Science and Engineering found that a softer, more elastic material could be better suited to the task of supporting the pelvic floor than polypropylene mesh.

They came to focus their research on polyurethane, and used a technique called electrospinning to create a very fine mesh. This could be assembled in layers to reflect the structure of human tissue.

The polyurethane material can have oestrogen inserted for slow release, encouraging the formation of new blood vessels and accelerating the healing of pelvic tissue following surgery. In their initial research, the team found that the polyurethane mesh was able to retain its strength and elasticity, and was not compromised by the addition of oestrogen.

If the material passes successfully through clinical trials and approval, it could, the researchers hope, have a positive impact on the millions of women worldwide who require mesh operations.

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