Effect of the surface modification of the synthetic meshes used in the surgical treatment of pelvic organ prolapse on the tissue adhesion and clinical functionality

Stress urinary incontinence and pelvic organ prolapse represent important conditions affecting adult women's health. Lately, the properties and performance of the polymer materials used in the treatment of pelvic organ prolapse have been improved by modulating from their formula. Materials investigated in our study are polypropylene meshes used by clinicians in surgical treatment of urinary incontinence and utero-vaginal prolapse. In order to make a comparative analysis, we confronted the structure and surface morphology of native synthetic polypropylene meshes with explanted fragments from the same mesh type after clinical use. FTIR investigations revealed little change in structure after implantation, somehow insignificant. Scanning electron microscopy (SEM) demonstrates modification in surface morphology even just by passing through the transobturator passage, whereas after implantation the surface deteriorates. SEM on explanted meshes proves the encapsulation process of the mesh to be more similar to a foreign body reaction rather than to the adhesion and integration of the synthetic mesh into the organism. Histological analysis of the surrounding tissues near explanted mesh was made in some relevant clinical cases, because the tissue response is an important factor in order to evaluate the tissue adhesion at the polypropylene mesh surface. Based on our experiments and clinical experience we've designed an adhesion score. It applies to meshes used in pelvic organ prolapse surgery measuring the following important factors: tenacity, extent of adhesion, macroscopic and microscopic aspects and ease of dissection from surrounding tissues.