Characterizing the ex vivo textile and structural properties of synthetic prolapse mesh products

Abstract

Introduction and hypothesis: The use of polypropylene meshes for surgical repair of pelvic organ prolapse (POP) has been limited by complications, including mesh exposure, encapsulation, and pain. Numerous products are available with a wide array of textile and structural properties. It is thought that complications may be related, in part, to mesh structural properties. However, few descriptions of these properties exists to directly compare products. The aim of this study was to determine the textile and structural properties of five commonly used prolapse mesh products using a ball-burst failure protocol.

Methods: Porosity, anisotropic index, and stiffness of Gynemesh PS (n = 8), the prototype polypropylene mesh for prolapse repair, was compared with four newer-generation mesh produces: UltraPro (n = 5), SmartMesh (n = 5), Novasilk (n = 5), and Polyform (n = 5).

Results: SmartMesh was found to be the most porous, at 78 % ± 1.4 %. This value decreased by 21 % for Gynemesh PS (p < 0.001), 14 % for UltraPro and Novasilk (p < 0.001), and 28 % for Polyform (p < 0.001). Based on the knit pattern, SmartMesh and Polyform were the only products considered to be geometrically isotropic, whereas all other meshes were anisotropic. Comparing the structural properties of these meshes, Gynemesh PS and Polyform were the stiffest: 60 % and 42 % stiffer than SmartMesh (p < 0.001) and Novasilk (p < 0.001), respectively. However, no significant differences were found between these two mesh products and UltraPro.

Conclusions: Porosity, anisotropy, and biomechanical behavior of these five commonly used polypropylene mesh products were significantly different. This study provides baseline data for future implantation studies of prolapse mesh products.

Fig. 1

Gross fiber network for Gynemesh PS (a), UltraPro (b), SmartMesh (c), Novasilk (d), and Polyform (e)

Fig. 2

Representative load-extension failure curves from the ball-burst protocol

Fig. 3

Stiffness of Gynemesh PS (n=8), UltraPro (n=5), SmartMesh (n=5), Novasilk (n=5), and Polyform (n=5) calculated from the ball-burst protocol. *Significant difference from Gynemesh PS, the prototype polypropylene prolapse mesh