The Experts below are selected from a list of 11787 Experts worldwide ranked by ideXlab platform
Sheila Macneil - One of the best experts on this subject based on the ideXlab platform.
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landmarks in vaginal Mesh development polypropylene Mesh for treatment of sui and pop
Nature Reviews Urology, 2019Co-Authors: Naşide Mangir, Christopher R Chapple, Betul Aldemir Dikici, Sheila MacneilAbstract:Vaginal Meshes used in the treatment of stress urinary incontinence (SUI) and pelvic organ prolapse (POP) have produced highly variable outcomes, causing life-changing complications in some patients while providing others with effective, minimally invasive treatments. The risk:benefit ratio when using vaginal Meshes is a complex issue in which a combination of several factors, including the inherent incompatibility of the Mesh material with some applications in pelvic reconstructive surgeries and the lack of appropriate regulatory approval processes at the time of the premarket clearance of these products, have contributed to the occurrence of complications caused by vaginal Mesh. Surgical Mesh used in hernia repair has evolved over many years, from metal implants to knitted polymer Meshes that were adopted for use in the pelvic floor for treatment of POP and SUI. The evolution of the material and textile properties of the Surgical Mesh was guided by clinical feedback from hernia repair procedures, which were also being modified to obtain the best outcomes with use of the Mesh. Current evidence shows how Surgical Mesh fails biomechanically when used in the pelvic floor and materials with improved performance can be developed using modern material processing and tissue engineering techniques.
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Complications related to use of Mesh implants in Surgical treatment of stress urinary incontinence and pelvic organ prolapse: infection or inflammation?
World Journal of Urology, 2019Co-Authors: Naşide Mangir, Sabiniano Roman, Christopher R Chapple, Sheila MacneilAbstract:The Surgical Mesh material used in the Surgical treatment of stress urinary incontinence (SUI) and pelvic organ prolapse (POP) in women is associated with significant complications in some women. This has recently become a public health issue with involvement of national parliaments and regulatory bodies. The occurrence of Mesh complications is thought to be a result of multifactorial processes involving problems related to the material design, the Surgical techniques used and disease, and patient-related factors. However, the infectious complications and Mesh–tissue interactions are least studied. The aim of this article is to review any previous clinical and basic scientific evidence about the contribution of infectious and inflammatory processes to the occurrence of Mesh-related complications in SUI and POP. A literature search for the relevant publications without any time limits was performed on the Medline database. There is evidence to show that vaginal Meshes are associated with an unfavourable host response at the site of implantation. The underlying mechanisms leading to this type of host response is not completely clear. Mesh contamination with vaginal flora during Surgical implantation can be a factor modifying the host response if there is a subclinical infection that can trigger a sustained inflammation. More basic science research is required to identify the biological mechanisms causing a sustained inflammation at the Mesh–tissue interface that can then lead to contraction, Mesh erosion, and pain.
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oestradiol releasing biodegradable Mesh stimulates collagen production and angiogenesis an approach to improving biomaterial integration in pelvic floor repair
European urology focus, 2017Co-Authors: Naşide Mangir, Christopher R Chapple, Christopher Hillary, Sheila MacneilAbstract:Abstract Background Polypropylene Meshes cause severe complications in some patients. Materials that are biomechanically compatible and can better integrate into host tissues are urgently needed. Objective To design an oestradiol-releasing electrospun poly- l -lactic acid (PLA) Mesh and evaluate its ability to stimulate new extracellular matrix and new blood vessel formation. Design, setting, and participants Human adipose derived mesenchymal cells (ADMSC) were isolated from fat. PLA Meshes with micro- to nano-sized fibres containing 1%, 5%, and 10% oestradiol were constructed and used for in vitro and in vivo experiments. Intervention The angiogenic potential of the fibrous Meshes was evaluated using an in vivo chorioallantoic membrane and an in vitro chick aortic arch assays. Outcome measurements and statistical analysis Oestradiol release was measured fluorometrically. The effect of fibrous Meshes on proliferation and extracellular matrix (ECM) production of ADMSC was assessed using immunohistology. Mechanical properties were tested using a tensiometer. Results and limitations The ultrastructure of the Mesh was not affected by the inclusion of oestradiol and mechanical properties were only slightly modified. Oestradiol was released from PLA Meshes over a 5-mo period. ADMSCs cultured on oestradiol-releasing PLA Meshes produced more ECM involving collagen I, collagen III, and elastin. Oestradiol-releasing Meshes doubled new blood vessel formation in the chorioallantoic membrane assay ( p = 0.001) and outgrowth of pro-angiogenic cells in the aortic arch assay ( p = 0.001). Further studies in longer-term animal models are required to confirm these results. Conclusions Oestradiol-releasing PLA Meshes increase ECM production and stimulate angiogenesis. As such, they are promising candidate materials to be used in pelvic floor repair and to improve the initial healing phase of a repair material following implantation. Patient summary In this study, we designed a tissue engineered material to be used to support weakened pelvic floor tissues in women to avoid the complications associated with current Surgical Mesh. Our results showed that this material can stimulate new blood vessel formation in simple chick assays and tissue production in vitro. Both properties should help with the integration of this material into patients’ tissues and merit further study in physiologically relevant animal models.
Naşide Mangir - One of the best experts on this subject based on the ideXlab platform.
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landmarks in vaginal Mesh development polypropylene Mesh for treatment of sui and pop
Nature Reviews Urology, 2019Co-Authors: Naşide Mangir, Christopher R Chapple, Betul Aldemir Dikici, Sheila MacneilAbstract:Vaginal Meshes used in the treatment of stress urinary incontinence (SUI) and pelvic organ prolapse (POP) have produced highly variable outcomes, causing life-changing complications in some patients while providing others with effective, minimally invasive treatments. The risk:benefit ratio when using vaginal Meshes is a complex issue in which a combination of several factors, including the inherent incompatibility of the Mesh material with some applications in pelvic reconstructive surgeries and the lack of appropriate regulatory approval processes at the time of the premarket clearance of these products, have contributed to the occurrence of complications caused by vaginal Mesh. Surgical Mesh used in hernia repair has evolved over many years, from metal implants to knitted polymer Meshes that were adopted for use in the pelvic floor for treatment of POP and SUI. The evolution of the material and textile properties of the Surgical Mesh was guided by clinical feedback from hernia repair procedures, which were also being modified to obtain the best outcomes with use of the Mesh. Current evidence shows how Surgical Mesh fails biomechanically when used in the pelvic floor and materials with improved performance can be developed using modern material processing and tissue engineering techniques.
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Complications related to use of Mesh implants in Surgical treatment of stress urinary incontinence and pelvic organ prolapse: infection or inflammation?
World Journal of Urology, 2019Co-Authors: Naşide Mangir, Sabiniano Roman, Christopher R Chapple, Sheila MacneilAbstract:The Surgical Mesh material used in the Surgical treatment of stress urinary incontinence (SUI) and pelvic organ prolapse (POP) in women is associated with significant complications in some women. This has recently become a public health issue with involvement of national parliaments and regulatory bodies. The occurrence of Mesh complications is thought to be a result of multifactorial processes involving problems related to the material design, the Surgical techniques used and disease, and patient-related factors. However, the infectious complications and Mesh–tissue interactions are least studied. The aim of this article is to review any previous clinical and basic scientific evidence about the contribution of infectious and inflammatory processes to the occurrence of Mesh-related complications in SUI and POP. A literature search for the relevant publications without any time limits was performed on the Medline database. There is evidence to show that vaginal Meshes are associated with an unfavourable host response at the site of implantation. The underlying mechanisms leading to this type of host response is not completely clear. Mesh contamination with vaginal flora during Surgical implantation can be a factor modifying the host response if there is a subclinical infection that can trigger a sustained inflammation. More basic science research is required to identify the biological mechanisms causing a sustained inflammation at the Mesh–tissue interface that can then lead to contraction, Mesh erosion, and pain.
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oestradiol releasing biodegradable Mesh stimulates collagen production and angiogenesis an approach to improving biomaterial integration in pelvic floor repair
European urology focus, 2017Co-Authors: Naşide Mangir, Christopher R Chapple, Christopher Hillary, Sheila MacneilAbstract:Abstract Background Polypropylene Meshes cause severe complications in some patients. Materials that are biomechanically compatible and can better integrate into host tissues are urgently needed. Objective To design an oestradiol-releasing electrospun poly- l -lactic acid (PLA) Mesh and evaluate its ability to stimulate new extracellular matrix and new blood vessel formation. Design, setting, and participants Human adipose derived mesenchymal cells (ADMSC) were isolated from fat. PLA Meshes with micro- to nano-sized fibres containing 1%, 5%, and 10% oestradiol were constructed and used for in vitro and in vivo experiments. Intervention The angiogenic potential of the fibrous Meshes was evaluated using an in vivo chorioallantoic membrane and an in vitro chick aortic arch assays. Outcome measurements and statistical analysis Oestradiol release was measured fluorometrically. The effect of fibrous Meshes on proliferation and extracellular matrix (ECM) production of ADMSC was assessed using immunohistology. Mechanical properties were tested using a tensiometer. Results and limitations The ultrastructure of the Mesh was not affected by the inclusion of oestradiol and mechanical properties were only slightly modified. Oestradiol was released from PLA Meshes over a 5-mo period. ADMSCs cultured on oestradiol-releasing PLA Meshes produced more ECM involving collagen I, collagen III, and elastin. Oestradiol-releasing Meshes doubled new blood vessel formation in the chorioallantoic membrane assay ( p = 0.001) and outgrowth of pro-angiogenic cells in the aortic arch assay ( p = 0.001). Further studies in longer-term animal models are required to confirm these results. Conclusions Oestradiol-releasing PLA Meshes increase ECM production and stimulate angiogenesis. As such, they are promising candidate materials to be used in pelvic floor repair and to improve the initial healing phase of a repair material following implantation. Patient summary In this study, we designed a tissue engineered material to be used to support weakened pelvic floor tissues in women to avoid the complications associated with current Surgical Mesh. Our results showed that this material can stimulate new blood vessel formation in simple chick assays and tissue production in vitro. Both properties should help with the integration of this material into patients’ tissues and merit further study in physiologically relevant animal models.
Shlomo Raz - One of the best experts on this subject based on the ideXlab platform.
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trends in Surgical Mesh use for pelvic organ prolapse from 2000 to 2010
Obstetrics & Gynecology, 2012Co-Authors: Lisa Rogogupta, Larissa V Rodriguez, Mark S Litwin, Thomas J Herzog, Alfred I Neugut, Shlomo Raz, Dawn L Hershman, Jason D WrightAbstract:OBJECTIVE To describe trends in and predictors of Surgical Mesh use for pelvic organ prolapse (POP) repair and to estimate the influence of safety advisories on Mesh use. METHODS Analysis of women aged 18 years and older recorded in a health care quality and resource utilization database who underwent POP repair from 2000 to 2010, identified by International Classification of Diseases, 9th Revision, Clinical Modification procedure codes, and stratified by Mesh use. Odds ratios were calculated with adjustments for patient, physician, and hospital-level characteristics. RESULTS Among 273,275 women in the cohort, 64,968 (23.8%) underwent a Mesh-augmented repair. Concurrent incontinence surgery was a strong predictor of Mesh use (odds ratio [OR] 9.95; 95% confidence interval [CI] 9.70-10.21). Mesh use increased from 7.9% in 2000 to a peak of 32.1% in 2006, and declined slightly to 27.5% in 2010. Among women without incontinence, Mesh use increased from 3.3% in 2000 to 13.5% in 2006, and remained stable at 12.8% in 2010. Intermediate-volume (OR 1.53; 95% CI 1.44-1.62) and high-volume (OR 2.74; 95% CI 2.58-2.92) surgeons were more likely to use Mesh than low-volume surgeons. Compared with women who underwent operation by gynecologists, those treated by urologists were more than three times more likely to undergo Mesh-augmented prolapse repair (OR 3.36; 95% CI 3.09-3.66). Black women were 27% less likely to undergo Mesh repair (OR 0.73; 95% CI 0.66-0.82). CONCLUSIONS Mesh-augmented prolapse repairs increased substantially over the past decade, and this increase was most pronounced in the years before the publication of safety advisories. Physician specialty and Surgical volume are important factors underlying Mesh use. Additional measures must ensure evidence-based use of Mesh for pelvic reconstruction. LEVEL OF EVIDENCE II.
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repair of vaginal vault prolapse and pelvic floor relaxation using polypropylene Mesh
Current Opinion in Obstetrics & Gynecology, 2006Co-Authors: Arthur Mourtzinos, Shlomo RazAbstract:Purpose of reviewInnumerable techniques have been described for vaginal vault prolapse and enterocele repair including abdominal (open, laparoscopic, and robotic) and vaginal techniques. Recently, the use of Surgical Mesh in pelvic floor surgery has become increasingly popular due to the high incide
A J Sims - One of the best experts on this subject based on the ideXlab platform.
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complications following vaginal Mesh procedures for stress urinary incontinence an 8 year study of 92 246 women
Scientific Reports, 2017Co-Authors: Kim Keltie, Sohier Elneil, Ashwani Monga, Hannah Patrick, John Powell, Bruce Campbell, A J SimsAbstract:Complications of Surgical Mesh procedures have led to legal cases against manufacturers worldwide and to national inquiries about their safety. The aim of this study was to investigate the rate of adverse events of these procedures for stress urinary incontinence in England over 8 years. This was a retrospective cohort study of first-time tension-free vaginal tape (TVT), trans-obturator tape (TOT) or suprapubic sling (SS) Surgical Mesh procedures between April 2007 and March 2015. Cases were identified from the Hospital Episode Statistics database. Outcomes included number and type of procedures, including those potentially confounded by concomitant procedures, and frequency, nature and timing of complications. 92,246 first-time Surgical Mesh procedures (56,648 TVT, 34,704 TOT, 834 SS and 60 combinations) were identified, including 68,002 unconfounded procedures. Peri-procedural and 30-day complication rates in the unconfounded cohort were 2.4 [2.3–2.5]% and 1.7 [1.6–1.8]% respectively; 5.9 [5.7–6.1]% were readmitted at least once within 5 years for further Mesh intervention or symptoms of complications, the highest risk being within the first 2 years. Complication rates were higher in the potentially confounded cohort. The complication rate within 5 years of the Mesh procedure was 9.8 [9.6:10.0]% This evidence can inform future decision-making on this procedure.
Giorgio Caccia - One of the best experts on this subject based on the ideXlab platform.
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Update in native tissue vaginal vault prolapse repair
International Urogynecology Journal, 2020Co-Authors: Andrea Braga, Maurizio Serati, Stefano Salvatore, Marco Torella, Roberto Pasqualetti, Andrea Papadia, Giorgio CacciaAbstract:The lifetime risk of women for undergoing surgery for pelvic organ prolapse (POP) is estimated to be 11–19%, and 30% of these women will require subsequent reoperation over time. Following hysterectomy, 3.6 per 1,000 person-years need Surgical correction of prolapse, and in two-thirds of these cases multi-compartment prolapse is present. In the last decades, vaginally synthetic Meshes were widely used in pelvic reconstructive surgery. However, after the decision of the Food and Drug Administration in 2019 to stop selling all Surgical Mesh devices for transvaginal prolapse repair, native tissue (NT) vaginal repair seems to regain an important role in pelvic reconstructive surgery. In the literature, various Surgical techniques have been described for apical repair, but the best Surgical approach is still to be proven. This paper analyzes the current evidence from recent literature on NT vaginal vault prolapse (VVP) repair, with special focus on the safety and efficacy of the various vaginal techniques.