Biomaterials for Pelvic Floor Reconstructive Surgery: How Can We Do Better?

Table 5

Polypropylene meshes.

Author	Sample	Biomechanical properties	Host response
Falconer et al., 2001 [89]	16 women were implanted with TVT for up to 2 years: 6 with Mersilene and 10 with Prolene.		Mersilene induces higher inflammatory response than Prolene. Mersilene is easier to extract than Prolene.
Klinge et al., 2002 [80]	Heavy weight monofilament with small pore size (HWM) and low weight with large pore size multifilament (LWM) on the posterior abdominal wall of rats for 7, 14, 21, and 90 days.		(i) HWM: intense inflammation, embedded in connective tissue.; (ii) LWM: less pronounced inflammatory response and fibrotic capsule, with collagen distributed within the mesh.
Wang et al., 2004 [90]	17 women with sling erosion and 7 women with voiding difficulties implanted with TVT and SPARC.		Pronounced fibrosis around the fibers—erosion and voiding difficulty as a result.
Rabah et al., 2004 [84]	Implantation of Surgipro and cadaveric fascia lata in rabbit’s bladder neck for 6 and 12 weeks.		(i) Cadaveric fascia lata group: the implant was incorporated in a plate of fibrous tissue.; (ii) Polypropylene mesh: inflammation localized on the graft.
Spiess et al., 2004 [35]	TVT and cadaveric fascia lata implanted in abdominal wall of rats for 6 and 12 weeks.	TVT has the greater break load and the maximum average load compared to cadaveric fascia lata.
Zheng et al., 2004 [81]	Prolene and Pelvicol implanted in full thickness abdominal wall defects in rats for 7, 14, 30, and 90 days.		Prolene prosthesis shows the presence of leukocytes in the activated state.
Konstantinovic et al., 2005 [50]	Marlex and non-cross-linked Surgisis implanted on the anterior abdominal wall of rats for 7, 14, 30, and 90 days.		(i) Marlex: more pronounced inflammatory reaction and vascularization throughout the graft than Surgisis; (ii) Surgisis: milder inflammatory reaction.
Yildirim et al., 2005 [38]	Gynecare TVT, SPARC, polypropylene mesh, and IVS implanted in contact with the rats rectus muscle for up to 30 days.		Inflammation and fibrosis are decreased in large pore meshes.
Thiel et al., 2005 [58]	Monofilament polypropylene mesh, silicone mesh, SIS, and PLA were implanted subcutaneously on the abdomen of rats for 7, 30, and 90 days.		Polypropylene induces the mildest inflammatory response among the samples.
Bogusiewicz et al., 2006 [83]	Monofilament TVT and multifilament IVS were implanted in rats rectus fascia for 42 days.		(i) They induce production of similar amount of collagen.; (ii) Differences in the arrangement of collagen and inflammation intensity.
Boulanger et al., 2006 [87]	Vicryl, Vypro, Prolene, Prolene Soft, and Mersuture were implanted in pigs peritoneum for 10 weeks.		(i) Vicryl: low level of inflammation and completely absorbed.; (ii) Vypro: intense inflammation and strong fibrotic response.; (iii) Prolene and Prolene Soft: well integrated, weak inflammatory response.; (iv) Mersuture: no good integration.
Krambeck et al., 2006 [26]	SPARC mesh, human cadaveric fascia, porcine dermis, SIS, and autologous fascia were implanted in rabbits rectus fascia for 12 weeks.		(i) Polypropylene mesh has the greatest scar formation.; (ii) Polypropylene has the mildest inflammatory response.
Boukerrou et al., 2007 [75]	Preperitoneal implantation of Vicryl, Vypro, Prolene, Prolene Soft, and Mersuture mesh for 2 months in pigs.	Nonabsorbable, monofilamentous, macroporous materials (type I) seem more resistant, retract less, and have the best tolerance.	.
Spelzini et al., 2007 [82]	Polypropylene type I mesh and macroporous silk construct were implanted in rat fascial defects for 7, 14, 30, and 90 days.		Polypropylene meshes induce a moderate inflammatory response and not architectural degradation.
Zorn et al., 2007 [74]	Rat abdominal wall was implanted with SPARC, TVT, and SIS for 6 weeks and 9, 6, 9, and 12 months.	TVT has tensile properties similar to SPARC and they are superior to Stratasis.
Bazi et al., 2007 [76]	Rats rectus fascia was implanted with Advantage, IVS, SPARC, and TVT for up to 24 weeks.	They all show similar mechanical properties after removal.	They induce different host responses due to different porosity.
Tayrac et al., 2007	Ewes vaginas were implanted with a noncoated LW polypropylene mesh (Soft Prolene) and a coated one (Ugytex) from 1 to 12 weeks.		Similar inflammatory response between the two materials.
Huffaker et al., 2008 [86]	Rabbits vaginas were implanted with Pelvitex (collagen-coated) and Gynemesh (uncoated polypropylene meshes) for up to 12 weeks.		Both materials induce a mild foreign body reaction with minimal fibrosis.
Woodruff et al., 2008 [27]	24 grafts were explanted in women undergoing sling revision after 2–34 months. Grafts were polypropylene meshes, autologous fascia, porcine dermis, and cadaveric dermis.		No evidence of degradation or encapsulation, abundant host infiltration. Neovascularisation was visible.
Elmer et al., 2009 [91]	Prolift was implanted in humans for 1 year.		(i) Increase in macrophages and mast cells count.; (ii) Mild but persistent foreign body response.
Pierce et al., 2009 [65]	Polypropylene mesh versus cross-linked porcine dermis implanted in rabbits vagina and abdomen for 9 months.		Polypropylene caused milder inflammatory reaction, more long term, good host tissue incorporation.
Melman et al., 2011 [77]	Bard mesh (HWPP), Ultrapro (LWPP), and GORE INFINIT Mesh (ePTFE) in minipigs hernia repair for 1, 3, and 5 months.	Their maximum tensile strength decreases for all of them.	(i) Inflammation decreases with time.; (ii) Cell infiltration increases with time.
Pascual et al., 2012 [85]	Surgipro, Optilene, and GORE INFINIT Mesh (ePTFE) were implanted in rabbits abdominal wall defect for 14 days.	LWPP implants might be improved by the newly formed tissue around it.	(i) PTFE induces an increased macrophage response when compared to polypropylene.; (ii) Increase in collagen deposition in high porosity meshes.
Manodoro et al., 2013 [78]	Gynemesh in two sizes ( mm and  mm) implanted in 20 adult ewes for 60 and 90 days, both on the abdominal and vaginal walls.	Implants were contracting more when implanted on the vaginal wall, compared to abdominal wall.; Grafts implanted on the vaginal wall are stiffer than the ones implanted on the abdominal wall, after retrieval.	(i) 30% of the meshes caused vaginal erosion and exposure.; (ii) 60% of the meshes had reduced surface (i.e., contracting after 90 days.)

HWPP: heavy weight polypropylene.
LWPP: lightweight polypropylene (also called soft); ePTFE: expanded polytetrafluoroethylene; PLGA: polylactide-co-glycolide acid; PLA: polylactide acid; PGA: polyglycolide acid.