Abstract
Stress urinary incontinence (SUI) was managed with techniques such as colposuspension,
autologous fascia sling and urethral bulking agents. The introduction of the mid-urethral
polypropylene (PP) sling in the 1990s led to a significant and rapid global change
in SUI surgery. The synthetic non-degradable PP sling had superior results to traditional
SUI procedures but its use has now declined due to significant complications such
as pain and mesh erosion. These complications are attributed to its poor biocompatibility
and integration into vaginal tissues. The efficacy of PP was extrapolated from studies
on abdominal wall repair and it is now clear that integration of implanted materials
in the pelvic floor differs from the abdominal wall. With PP prohibited in some jurisdictions,
female patients with SUI have few management options. In the present review we summarise
recent advances in SUI surgery and evaluate potential alternatives to PP slings with
a particular focus on degradable materials. Allograft and xenograft materials demonstrate
good biocompatibility but have yielded suboptimal cure rates. Tissue engineered synthetic
degradable materials outperform unmodified synthetic degradable materials in terms
of biomechanics and cell support. Synthetic tissue engineered degradable materials
show promising results from in vitro studies and future research should focus on animal and human trials in this field.
Abbreviations:
PP (polypropylene), SUI (stress urinary incontinence), MUS (mid-urethral sling), POP (pelvic organ prolapse), FDA (food and drug administration), ECM (extracellular matrix), PLA (polylactic acid), ADSC (adipose derived stem cells), PLGA (Poly-DL-lactico-glycolic acid), PLGA/PCL (poly(glycolide-co-lactide acid)-blended-poly(caprolactone), SIS (small intestinal submucosa), LPP (leak-point pressure), MPa (megapascal), eMSC (endometrial mesenchymal stem cells), PA (polyamide)Keywords
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Article info
Publication history
Published online: February 26, 2021
Accepted:
February 24,
2021
Received in revised form:
February 18,
2021
Received:
January 11,
2021
Identification
Copyright
© 2021 Elsevier B.V. All rights reserved.
