The paper published by Steven Abramowitch, Associate Professor of Bioengineering at the University of Pittsburgh, and McGowan Institute for Regenerative Medicine affiliated faculty member Pamela Moalli, MD, PhD, Associate Professor, Department of Obstetrics, Gynecology & Reproductive Sciences, Division of Urogynecology & Pelvic Reconstructive Surgery, Magee-Womens Hospital of UPMC, University of Pittsburgh, was recently recognized by the editors of the Journal of Biomechanical ok work. The article details complications associated with mechanical loads on synthetic mesh used in pelvic organ prolapse and will be listed as an Editors’ Choice paper in JBME’s Annual Special Issue February 2020.
Pelvic organ prolapse (POP) is a condition where the organs in the pelvis push against the vagina, creating a “bulge” that can extend outside of the body. It results from a weakening of the muscles and tissues that help support the pelvic organs. Despite the fact that 12.6 percent of women in the U.S. will undergo major surgery for POP by the age of 80, most of the studies surrounding these devices were conducted as they are applied to hernias in the abdomen. According to recent research, pelvic floor applications using this technology seem to be more vulnerable to mesh-related complications.
The team’s research in the Swanson School of Engineering and the Center for Interdisciplinary Research in Female Pelvic Health uses experimental and computational methods to examine the mechanical behavior of mesh so that it can be optimized for the female pelvic floor environment.
“The textile and structural properties of mesh have proven to be an important factor in its efficacy – particularly the pore size, which has shown to increase complications when less than 1mm in size,” said Dr. Abramowitch. “Even though these devices are widely used, the in vivo mechanical behavior of synthetic mesh is largely unknown, as is the impact of its mechanics on surrounding biological tissues.”
Though most vaginal mesh is developed with pore sizes large enough to minimize complications, researchers have recently discovered that mechanical loading significantly alters pore dimensions. While previous studies have looked at the effects of uniaxial loading, Dr. Abramowitch and his group are broadening research in this area by quantifying multiaxial loading.
“Transvaginal meshes, which are most commonly associated with complications and have been recently banned from use in the United States, are fixed at multiple locations in the pelvis. This creates multi-directional forces that cause the mesh to change shape in specific regions,” he explained. “Interestingly, our simulations predict the locations where the most shape change occurs, and they happen to be consistent with the most common sites for complications. This gives us a great possible lead to better understanding the mechanisms that cause mesh complications.”
Dr. Abramowitch’s group developed an experimental model to quantify pore dimensions in response to clinically relevant mechanical forces and a computational model to simulate the mechanical behavior of transvaginal mesh in response to these forces. By developing these models, they will be able to examine a wide range of mechanical conditions, predict mesh behavior, and eventually optimize devices for the female pelvic floor.
This research recently led to a $2,500,000 award from the National Institutes of Health to create a novel repair device designed for the vagina that may improve outcomes in POP surgery. Drs. Abramowitch and Moalli will lead this effort.
Abstract (Deformation of transvaginal mesh in response to multiaxial loading. William R. Barone, Katrina M. Knight, Pamela A. Moalli, Steven D. Abramowitch. Journal of Biomechanical Engineering, Feb 2019, 141(2): 021001 (8 pages).)