Haley Clark

Background: Female pelvic organ prolapse (POP) affects up to 50% of women in their lifetime and can impact daily lives by inhibiting coitus, causing urinary/bowel incontinence, pain, and sores.^1,2 Historically, synthetic meshes used in surgical repair were non-biodegradable, non-histocompatible, and mechanically mismatched, causing infections, exposure, and erosions. Consequently, the FDA banned polypropylene knitted (PP) meshes.¹ Electrospinning, a technique that produces extracellular matrix-like (ECM) ultrafine fibers, offers promise for enhancing tissue regeneration and overcoming traditional mesh implant limitations.¹

Methods: A PubMed literature review using the keywords “pelvic organ prolapse”, “tissue engineering”, “electrospinning”, and “electrospun meshes” was conducted, excluding studies older than five years.

Results: Electrospun meshes offer advantages over conventional knitted meshes. Their ECM-like structure facilitates greater fibroblast proliferation, collagen synthesis, and ECM deposition compared to traditional knitted meshes.² This increased cellular response increases tissue regeneration, potentially leading to better POP outcomes.² Electrospun meshes of ureidopyrimidinone-polycarbonate (UPy-PC) and polyurethane (PU) were tested against PP and native tissue in ewes.³ Results showed electrospun meshes provided adequate support and mechanical suitability.³ Additionally, electrospun meshes promoted neovascularization and increased cell infiltrates, particularly macrophages, with a higher M2/M1 ratio.³ Overall, electrospun meshes milder inflammatory response, and appropriate mechanical properties suggest their potential for POP.³  In another study, electrospun UPy-PC and PU meshes were compared to four commercial knitted meshes, demonstrating superior mechanical properties.⁴ They display excellent elasticity and deformation resistance, which withstands the dynamic stresses experienced by pelvic tissues.⁴  Additionally, electrospun meshes offer drug and cell delivery capabilities due to their high surface area and porosity.^2,1 They can be loaded with therapeutic agents or combined with stem cells without affecting their integrity.^2,1 For instance, 17β-estradiol (E2) electrospun meshes display controlled drug release, ensuring sustained therapeutic effects.² Moreover, they support the migration, attachment, and proliferation of endometrial mesenchymal stem cells, potentially enhancing tissue regeneration and repair for improved POP outcomes.¹  Furthermore, long-term human and animal studies, including elderly rats, suggest that electrospun meshes are biocompatible and effective for POP repair.⁵ Despite differences in collagen expression and tissue stiffness, electrospun meshes provide adequate support without long-term complications, making them suitable for aging populations.⁵

Conclusions: Electrospun meshes represent a promising solution to address the challenges associated with POP treatment due to their ECM-mimicking nature, mechanical properties, and drug/stem cell delivery capabilities. However, further research and long-term clinical trials are necessary to fully understand their potential in improving patient outcomes and quality of life.

Works Cited:

1. Paul K, Darzi S, McPhee G, et al. 3D bioprinted endometrial stem cells on melt electrospun poly ε-caprolactone mesh for pelvic floor application promote anti-inflammatory responses in mice. Acta Biomater. 2019;97:162-176. doi:10.1016/j.actbio.2019.08.003
2. Verhorstert K, Gudde A, Weitsz C, Bezuidenhout D, Roovers JP, Guler Z. Absorbable Electrospun Poly-4-hydroxybutyrate Scaffolds as a Potential Solution for Pelvic Organ Prolapse Surgery. ACS Appl Bio Mater. 2022;5(11):5270-5280. doi:10.1021/acsabm.2c00691
3. Hympánová L, Rynkevic R, Román S, et al. Assessment of Electrospun and Ultra-lightweight Polypropylene Meshes in the Sheep Model for Vaginal Surgery. Eur Urol Focus. 2020;6(1):190-198. doi:10.1016/j.euf.2018.07.024
4. Roman S, Mangir N, Hympanova L, Chapple CR, Deprest J, MacNeil S. Use of a simple in vitro fatigue test to assess materials used in the surgical treatment of stress urinary incontinence and pelvic organ prolapse. Neurourol Urodyn. 2019;38(1):107-115. doi:10.1002/nau.23823
5. Laursen SH, Hansen SG, Taskin MB, et al. Electrospun nanofiber mesh with connective tissue growth factor and mesenchymal stem cells for pelvic floor repair: Long-term study. J Biomed Mater Res B Appl Biomater. 2023;111(2):392-401. doi:10.1002/jbm.b.35158