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Guler Z, Kaestner LA, Vodegel E, Ras L, Jeffrey S, Roovers JP. Two-Year Preclinical Evaluation of Long-Term Absorbable Poly-4-hydroxybutyrate Scaffold for Surgical Correction of Pelvic Organ Prolapse. Int Urogynecol J 2024; 35:713-722. [PMID: 38430238 PMCID: PMC11024044 DOI: 10.1007/s00192-023-05720-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 12/14/2023] [Indexed: 03/03/2024]
Abstract
INTRODUCTION AND HYPOTHESIS Fully absorbable implants may be an alternative to permanent meshes in the correction pf pelvic organ prolapse (POP) as they may reduce adverse events by promoting tissue regeneration and collagen metabolism. This study was aimed at evaluating the long-term host and biomechanical response to a fully absorbable poly-4-hydroxybutyrate (P4HB) scaffold in comparison with polypropylene (PP) mesh. METHODS Poly-4-hydroxybutyrate scaffold (n = 16) and PP mesh (n = 16) were surgically implanted in the posterior vaginal wall of parous female Dohne Merino sheep. Vaginal explants were evaluated in terms of gross necropsy, host response (immune response, collagen deposition, tissue regeneration), biomechanics, and degradation of P4HB at 12 and 24 months post-implantation. RESULTS Gross necropsy revealed no infection or fluid collection using P4HB or PP. At 12 months, exposures were observed with both P4HB (3 out of 8) and PP (4 out of 8), whereas at 24 months, exposures were observed only with PP (4 out of 8). The tensile stiffness of the P4HB explants was maintained over time despite complete absorption of P4HB. The collagen amount of the vaginal tissue after P4HB implantation increased over time and was significantly higher than PP at 24 months. P4HB scaffolds exhibited significantly lower myofibroblast differentiation than PP meshes at 24 months. CONCLUSIONS The P4HB scaffold allowed for gradual load transfer to the vaginal wall and resulted in mechanically self-sufficient tissue. P4HB scaffold had a more favorable host response than PP mesh, with higher collagen content, lower myofibroblastic differentiation, and no exposures at 24 months. P4HB scaffolds have potential as an alternative to permanent implants in treating POP.
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Affiliation(s)
- Zeliha Guler
- Department of Obstetrics and Gynaecology, Amsterdam UMC - location AMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands.
- Amsterdam Reproduction and Development, Amsterdam, The Netherlands.
| | - Lisa Ann Kaestner
- Department of Urology, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Eva Vodegel
- Department of Obstetrics and Gynaecology, Amsterdam UMC - location AMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development, Amsterdam, The Netherlands
| | - Lamees Ras
- Department of Obstetrics and Gynecology, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Stephen Jeffrey
- Department of Obstetrics and Gynecology, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Jan Paul Roovers
- Department of Obstetrics and Gynaecology, Amsterdam UMC - location AMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development, Amsterdam, The Netherlands
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Diedrich CM, Guler Z, Hympanova L, Vodegel E, Zündel M, Mazza E, Deprest J, Roovers JP. Evaluation of the short-term host response and biomechanics of an absorbable poly-4-hydroxybutyrate scaffold in a sheep model following vaginal implantation. BJOG 2021; 129:1039-1049. [PMID: 34865300 PMCID: PMC9303173 DOI: 10.1111/1471-0528.17040] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 11/19/2021] [Accepted: 11/30/2021] [Indexed: 12/01/2022]
Abstract
Objective To evaluate the host‐ and biomechanical response to a fully absorbable poly‐4‐hydroxybutyrate (P4HB) scaffold in comparison with the response to polypropylene (PP) mesh. Design In vivo animal experiment. Setting KU Leuven Center for Surgical Technologies. Population Fourteen parous female Mule sheep. Methods P4HB scaffolds were surgically implanted in the posterior vaginal wall of sheep. The comparative PP mesh data were obtained from an identical study protocol performed previously. Main outcome measures Gross necropsy, host response and biomechanical evaluation of explants, and the in vivo P4HB scaffold degradation were evaluated at 60‐ and 180‐days post‐implantation. Data are reported as mean ± standard deviation (SD) or standard error of the mean (SEM). Results Gross necropsy revealed no implant‐related adverse events using P4HB scaffolds. The tensile stiffness of the P4HB explants increased at 180‐days (12.498 ± 2.66 N/mm SEM [p =0.019]) as compared to 60‐days (4.585 ± 1.57 N/mm) post‐implantation, while P4HB degraded gradually. P4HB scaffolds exhibited excellent tissue integration with dense connective tissue and a moderate initial host response. P4HB scaffolds induced a significantly higher M2/M1 ratio (1.70 ± 0.67 SD, score 0–4), as compared to PP mesh(0.99 ± 0.78 SD, score 0–4) at 180‐days. Conclusions P4HB scaffold facilitated a gradual load transfer to vaginal tissue over time. The fully absorbable P4HB scaffold, in comparison to PP mesh, has a favorable host response with comparable load‐bearing capacity. If these results are also observed at longer follow‐up in‐vivo, a clinical study using P4HB for vaginal POP surgery may be warranted to demonstrate efficacy. Tweetable Abstract Degradable vaginal P4HB implant might be a solution for treatment of POP. Degradable vaginal P4HB implant might be a solution for treatment of POP.
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Affiliation(s)
- Chantal M Diedrich
- Department of Obstetrics and Gynaecology, Center for Reproductive Medicine (AMC), Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Zeliha Guler
- Department of Obstetrics and Gynaecology, Center for Reproductive Medicine (AMC), Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Lucie Hympanova
- Centre for Surgical Technologies, Biomedical Sciences Group, KU Leuven, Leuven, Belgium.,Third Faculty of Medicine, Institute for the Care of Mother and Child, Charles University, Prague, Czech Republic
| | - Eva Vodegel
- Department of Obstetrics and Gynaecology, Center for Reproductive Medicine (AMC), Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Manuel Zündel
- Institute of Mechanical Systems, ETH Zurich, Zurich, Switzerland.,Swiss Federal Laboratories for Materials Science and Technology, EMPA, Dübendorf, Switzerland
| | - Edoardo Mazza
- Institute of Mechanical Systems, ETH Zurich, Zurich, Switzerland.,Swiss Federal Laboratories for Materials Science and Technology, EMPA, Dübendorf, Switzerland
| | - Jan Deprest
- Centre for Surgical Technologies, Biomedical Sciences Group, KU Leuven, Leuven, Belgium
| | - Jan Paul Roovers
- Department of Obstetrics and Gynaecology, Center for Reproductive Medicine (AMC), Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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Mackova K, Mazzer AM, Mori Da Cunha M, Hajkova Hympanova L, Urbankova I, Kastelein AW, Vodegel E, Vander Linden K, Fehervary H, Guler Z, Roovers JP, Krofta L, Verhaeghe J, Deprest J. Vaginal Er:YAG laser application in the menopausal ewe model: a randomised estrogen and sham-controlled trial. BJOG 2020; 128:1087-1096. [PMID: 33017509 DOI: 10.1111/1471-0528.16558] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2020] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To describe effects of non-ablative erbium-doped:yttrium-aluminium-garnet (Er:YAG) laser on vaginal atrophy induced by iatrogenic menopause in the ewe. DESIGN Animal experimental, randomised, sham and estrogen-treatment controlled study with blinding for primary outcome. SETTING KU Leuven, Belgium. SAMPLE Twenty-four ewes. METHODS Menopause was surgically induced, after which the ewes were randomised to three groups receiving vaginal Er:YAG laser application three times, with a 1-month interval; three sham manipulations with a 1-month interval; or estrogen replacement and sham manipulations. At given intervals, ewes were clinically examined and vaginal wall biopsies were taken. Vaginal compliance was determined by passive biomechanical testing from explants taken at autopsy. MAIN OUTCOME MEASURES Vaginal epithelial thickness (primary), composition of the lamina propria (collagen, elastin, glycogen and vessel content), vaginal compliance, clinical signs. RESULTS Animals exposed to Er:YAG laser application and sham manipulation, but not to estrogens, displayed a significant and comparable increase in vaginal epithelial thickness between baseline and 7 days after the third application (69% and 67%, respectively, both P < 0.0008). In laser-treated ewes, temporary vaginal discharge and limited thermal injury were observed. Estrogen-substituted ewes displayed a more prominent increase in epithelial thickness (202%; P < 0.0001) and higher vaginal compliance (P < 0.05). None of the interventions induced changes in the lamina propria. CONCLUSIONS Vaginal Er:YAG laser has comparable effect to sham manipulation in menopausal ewes. TWEETABLE ABSTRACT Vaginal Er:YAG laser has comparable effect to sham manipulation in menopausal ewes #LASER #GSM #RCT.
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Affiliation(s)
- K Mackova
- Department of Development and Regeneration, Cluster Urogenital, Abdominal and Plastic Surgery, KU Leuven, Leuven, Belgium.,Third Faculty of Medicine, Institute for the Care of Mother and Child, Charles University, Prague, Czech Republic
| | - A M Mazzer
- Department of Obstetrics and Gynaecology, San Raffaele University, Milan, Italy
| | - Mgmc Mori Da Cunha
- Department of Development and Regeneration, Cluster Urogenital, Abdominal and Plastic Surgery, KU Leuven, Leuven, Belgium
| | - L Hajkova Hympanova
- Department of Development and Regeneration, Cluster Urogenital, Abdominal and Plastic Surgery, KU Leuven, Leuven, Belgium.,Third Faculty of Medicine, Institute for the Care of Mother and Child, Charles University, Prague, Czech Republic
| | - I Urbankova
- Third Faculty of Medicine, Institute for the Care of Mother and Child, Charles University, Prague, Czech Republic
| | - A W Kastelein
- Department of Obstetrics and Gynaecology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - E Vodegel
- Department of Obstetrics and Gynaecology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - K Vander Linden
- Department of Mechanical Engineering, KU Leuven, Leuven, Belgium
| | - H Fehervary
- Department of Mechanical Engineering, KU Leuven, Leuven, Belgium
| | - Z Guler
- Department of Obstetrics and Gynaecology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - J P Roovers
- Department of Obstetrics and Gynaecology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - L Krofta
- Third Faculty of Medicine, Institute for the Care of Mother and Child, Charles University, Prague, Czech Republic
| | - J Verhaeghe
- Department of Development and Regeneration, Cluster Urogenital, Abdominal and Plastic Surgery, KU Leuven, Leuven, Belgium.,Pelvic Floor Unit, University Hospitals KU Leuven, Leuven, Belgium
| | - J Deprest
- Department of Development and Regeneration, Cluster Urogenital, Abdominal and Plastic Surgery, KU Leuven, Leuven, Belgium.,Pelvic Floor Unit, University Hospitals KU Leuven, Leuven, Belgium
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Hympanova L, Mackova K, El-Domyati M, Vodegel E, Roovers JP, Bosteels J, Krofta L, Deprest J. Effects of non-ablative Er:YAG laser on the skin and the vaginal wall: systematic review of the clinical and experimental literature. Int Urogynecol J 2020; 31:2473-2484. [PMID: 32780174 DOI: 10.1007/s00192-020-04452-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 07/16/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Er:YAG laser is frequently used in dermatology and gynecology. Clinical studies document high satisfaction rates; however, hard data on the effects at the structural and molecular levels are limited. The aim of this systematic review was to summarize current knowledge about the objective effects of non-ablative Er:YAG laser on the skin and vaginal wall. METHODS We searched MEDLINE, Embase, Cochrane, and the Web of Science. Studies investigating objectively measured effects of non-ablative Er:YAG laser on the skin or vaginal wall were included. Studies of any design were included. Owing to the lack of methodological uniformity, no meta-analysis could be performed and therefore results are presented as a narrative review. RESULTS We identified in vitro or ex vivo studies on human cells or tissues, studies in rats, and clinical studies. Most studies were on the skin (n = 11); the rest were on the vagina (n = 4). The quality of studies is limited and the settings of the laser were very diverse. Although the methods used were not comparable, there were demonstrable effects in all studies. Immediately after application the increase in superficial temperature, partial preservation of epithelium and subepithelial extracellular matrix coagulation were documented. Later, an increase in epithelial thickness, inflammatory response, fibroblast proliferation, an increase in the amount of collagen, and vascularization were described. CONCLUSIONS Er:YAG laser energy may induce changes in the deeper skin or vaginal wall, without causing unwanted epithelial ablation. Laser energy initiates a process of cell activation, production of extracellular matrix, and tissue remodeling.
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Affiliation(s)
- Lucie Hympanova
- Centre for Surgical Technologies, Group Biomedical Sciences, KU Leuven, Herestraat 49, 3000, Leuven, Belgium.,Department of Development and Regeneration, Woman and Child, Group Biomedical Sciences, KU Leuven, Leuven, Belgium.,Institute for the Care of Mother and Child, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Katerina Mackova
- Centre for Surgical Technologies, Group Biomedical Sciences, KU Leuven, Herestraat 49, 3000, Leuven, Belgium.,Department of Development and Regeneration, Woman and Child, Group Biomedical Sciences, KU Leuven, Leuven, Belgium.,Institute for the Care of Mother and Child, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Moetaz El-Domyati
- Department of Dermatology and Venereology, Minia University, Al-Minya, Egypt
| | - Eva Vodegel
- Department of Obstetrics and Gynaecology, Amsterdam University Medical Center, location AMC, Amsterdam, The Netherlands
| | - Jan-Paul Roovers
- Department of Obstetrics and Gynaecology, Amsterdam University Medical Center, location AMC, Amsterdam, The Netherlands
| | - Jan Bosteels
- Department of Development and Regeneration, Woman and Child, Group Biomedical Sciences, KU Leuven, Leuven, Belgium.,CEBAM, The Centre for Evidence-based Medicine, Cochrane Belgium, KU Leuven-University of Leuven, Leuven, Belgium
| | - Ladislav Krofta
- Institute for the Care of Mother and Child, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Jan Deprest
- Centre for Surgical Technologies, Group Biomedical Sciences, KU Leuven, Herestraat 49, 3000, Leuven, Belgium. .,Department of Development and Regeneration, Woman and Child, Group Biomedical Sciences, KU Leuven, Leuven, Belgium. .,Pelvic Floor Unit, University Hospitals KU Leuven, Leuven, Belgium.
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