Experimental study of a new original mesh developed for pelvic floor reconstructive surgery

  • Fang-Fang Ai
  • Meng Mao
  • Ye Zhang
  • Jia Kang
  • Lan ZhuEmail author


Introduction and hypothesis

Most synthetic meshes used in transvaginal surgery are made of polypropylene, which has a stable performance, but does not easily degrade in vivo. However, mesh-related complications are difficult to address and have raised serious concerns. A new biomaterial mesh with good tissue integration and few mesh-related complications is needed. To evaluate the effect of a new bacterial cellulose (BC) mesh on pelvic floor reconstruction following implantation in the vagina of sheep after 1 and 12 weeks.


The meshes were implanted in the submucosa of the posterior vagina wall of sheep. At 1 and 12 weeks after surgery, mesh–tissue complex (MTC) specimens were harvested for histological studies and biomechanical evaluation. At 12 weeks after surgery, MTC specimens were biomechanically assessed by a uniaxial tension “pulley system”.


The BC mesh elicited a higher inflammatory response than Gynemesh™PS at both 1 and 12 weeks after implantation. Twelve weeks after implantation, the BC mesh resulted in less fibrosis than Gynemesh™PS. Compared with the Gynemesh™PS group, the BC mesh group had increased mRNA expression of MMP-1, MMP-2, and MMP-9 (P < 0.05), but decreased expression of the anti-inflammatory factor IL-4 (P < 0.05). Twelve weeks after implantation, the ultimate load and maximum elongation percentage of the BC mesh were significantly lower than those of Gynemesh™PS.


The BC mesh could not be a promising biomaterial for pelvic floor reconstructive surgery unless the production process and parameters were improved.


Bacterial cellulose Polypropylene mesh Histologic biocompatibility Biomechanics Sheep model 



The animal study was conducted at Beijing Key Laboratory of Pre-clinical Research and Evaluation for Cardiovascular Implant Materials. The authors thank Bin Li, Boqing Yang, and Liujun Jia, who participated in the anesthesia procedure of the sheep.


This study received financial support from the National Natural Science Foundation of China (number: 81771561), and Strategic Priority Research Program of the Chinese Academy of Sciences (XDA16010102).

Compliance with ethical standards

Conflicts of interest


Details of ethics approval

The study was approved by the ethics committee of FUWAI Hospital, Chinese Academy of Medical Sciences (0079-2-36-HX(X)).


  1. 1.
    Amrute KV, Eisenberg ER, Rastinehad AR, Kushner L, Badlani GH. Analysis of outcomes of single polypropylene mesh in total pelvic floor reconstruction. Neurourol Urodyn. 2007;26(1):53–8.CrossRefGoogle Scholar
  2. 2.
    Wu JM, Matthews CA, Conover MM, Pate V, Jonsson Funk M. Lifetime risk of stress urinary incontinence or pelvic organ prolapse surgery. Obstet Gynecol. 2014;123(6):1201–6.CrossRefGoogle Scholar
  3. 3.
    Barber MD, Brubaker L, Burgio KL, Richter HE, Nygaard I, Weidner AC, et al. Comparison of 2 transvaginal surgical approaches and perioperative behavioral therapy for apical vaginal prolapse. JAMA. 2014;311(10):1023.CrossRefGoogle Scholar
  4. 4.
    Klosterhalfen B, Klinge U, Henze U, Bhardwaj R, Conze J, Schumpelick V. Morphologische Korrelation der funktioneuen Bauchwandmechanik nach Mesh-implantation. Langenbecks Arch Chir. 1997;382:87–94.Google Scholar
  5. 5.
    Margulies RU, Lewicky-Gaupp C, Fenner DE, Mcguire EJ, Clemens JQ. Complications requiring reoperation following vaginal mesh kit procedures for prolapse. Am J Obstet Gynecol. 2008;199(6):678.e1–4.CrossRefGoogle Scholar
  6. 6.
    Baessler K, Maher CF. Mesh augmentation during pelvic-floor reconstructive surgery: risks and benefits. Curr Opin Obstet Gynecol. 2006;18(5):560–6.CrossRefGoogle Scholar
  7. 7.
    Falconer C, Söderberg M, Blomgren B, Ulmsten U. Influence of different sling materials on connective tissue metabolism in stress urinary incontinent women. Int Urogynecol J Pelvic Floor Dysfunct. 2001;12(Suppl 2):S19–23.CrossRefGoogle Scholar
  8. 8.
    Karlovsky ME, Thakre AA, Rastinehad A, Kushner L, Badlani GH. Biomaterials for pelvic floor reconstruction. Urology. 2005;66(3):469–75.CrossRefGoogle Scholar
  9. 9.
    Shankaran V, Weber DJ, Reed RL, Luchette FA. A review of available prosthetics for ventral hernia repair. Ann Surg. 2011;253(1):16–26.CrossRefGoogle Scholar
  10. 10.
    Lucyszyn N, Ono L, Lubambo AF, Woehl MA, Sens CV, de Souza CF, et al. Physicochemical and in vitro biocompatibility of films combining reconstituted bacterial cellulose with arabinogalactan and xyloglucan. Carbohyd Polym. 2016;151:889–98.CrossRefGoogle Scholar
  11. 11.
    Phisalaphong M, Jatupaiboon N. Biosynthesis and characterization of bacteria cellulose-chitosan film. Carbohydr Polym. 2008;74:482–8.CrossRefGoogle Scholar
  12. 12.
    Ma X, Zhang H, Chen SW. Feasibility of bacterial cellulose membrane as a wound dressing. J Clin Rehab Tissue Eng Res. 2010;14:2261–4.Google Scholar
  13. 13.
    Xu C, Ma X, Chen S, Tao M, Yuan L. Bacterial cellulose membranes used as artificial substitutes for Dural defection in rabbits. Int J Mol Sci. 2014;15(6):10855–67.CrossRefGoogle Scholar
  14. 14.
    Zang S, Zhang R, Chen H, Lu Y, Zhou J. Investigation on artificial blood vessels prepared from bacterial cellulose. Mater Sci Eng C Mater Biol Appl. 2015;46:111–7.CrossRefGoogle Scholar
  15. 15.
    Abramowitch SD, Feola A, Jallah Z, Moalli PA. Tissue mechanics, animal models, and pelvic organ prolapse: a review. Eur J Obstet Gynecol Reprod Biol. 2009;144:S146–58.CrossRefGoogle Scholar
  16. 16.
    Krause H, Goh J. Sheep and rabbit genital tracts and abdominal wall as an implantation model for the study of surgical mesh. J Obstet Gynaecol Res. 2009;35(2):219–24.CrossRefGoogle Scholar
  17. 17.
    Couri BM, Lenis AT, Borazjani A, Paraiso MFR, Damaser MS. Animal models of female pelvic organ prolapse: lessons learned. Expert Rev Obstet Gynecol. 2014;7(3):249–60.CrossRefGoogle Scholar
  18. 18.
    Jackson R, Hilson RP, Roe AR, Perkins N, Heuer C, West DM. Epidemiology of vaginal prolapse in mixed-age ewes in New Zealand. N Z Vet J. 2014;62(6):328–37.CrossRefGoogle Scholar
  19. 19.
    Hjort H, Mathisen T, Alves A, Clermont G, Boutrand JP. Three-year results from a preclinical implantation study of a long-term resorbable surgical mesh with time-dependent mechanical characteristics. Hernia. 2012;16(2):191–7.CrossRefGoogle Scholar
  20. 20.
    Junqueira LC, Cossermelli W, Brentani R. Differential staining of collagens type I, II and III by Sirius red and polarization. Arch Histol Jpn. 1978;41(3):267–74.CrossRefGoogle Scholar
  21. 21.
    Bellón JM, Contreras LA, Buján J, Palomares D, Carrera-San Mart NA. Tissue response to polypropylene meshes used in the repair of abdominal wall defects. Biomaterials. 1998;19(7):669–75.CrossRefGoogle Scholar
  22. 22.
    Gigliobianco G, Roman Regueros S, Osman NI, Bissoli J, Bullock AJ, Chapple CR, et al. Biomaterials for pelvic floor reconstructive surgery: how can we do better? Biomed Res Int. 2015;2015:968087. Scholar
  23. 23.
    Moore RD, Lukban JC. Comparison of vaginal mesh extrusion rates between a lightweight type I polypropylene mesh versus heavier mesh in the treatment of pelvic organ prolapse. Int Urogynecol J. 2012;23(10):1379–86.CrossRefGoogle Scholar
  24. 24.
    Patel H, Ostergard DR, Sternschuss G. Polypropylene mesh and the host response. Int Urogynecol J. 2012;23(6):669–79.CrossRefGoogle Scholar
  25. 25.
    Amid PK. Classification of biomaterials and their related complications in abdominal wall hernia surgery. Hernia. 1997;1:15–21.CrossRefGoogle Scholar
  26. 26.
    Miyamoto T, Takahashi S-i, Ito H, Inagak H. Tissue biocompatibility of cellulose and its derivatives. J Biomed Mater Res. 1989;23:125–33.CrossRefGoogle Scholar
  27. 27.
    Helenius G, Backdahl H, Bodin A, Nannmark U, Gatenholm P, Risberg B. In vivo biocompatibility of bacterial cellulose. J Biomed Mater Res A. 2006;76(2):431–8.CrossRefGoogle Scholar
  28. 28.
    Asarias JR, Nguyen PT, Mings JR, Gehrich AP, Pierce LM. Influence of mesh materials on the expression of mediators involved in wound healing. J Investig Surg. 2011;24(2):87–98.CrossRefGoogle Scholar
  29. 29.
    Ulrich D, Edwards SL, Letouzey V, et al. Regional variation in tissue composition and biomechanical properties of postmenopausal ovine and human vagina. PLoS One. 2014;9(8):e104972.CrossRefGoogle Scholar
  30. 30.
    Liang R, Abramowitch S, Knight K, Palcsey S, Nolfi A, Feola A, et al. Vaginal degeneration following implantation of synthetic mesh with increased stiffness. BJOG. 2013;120(2):233–43.CrossRefGoogle Scholar
  31. 31.
    Chen B, Yeh J. Alterations in connective tissue metabolism in stress incontinence and prolapse. J Urol. 2011;186(5):1768–72.CrossRefGoogle Scholar
  32. 32.
    Fan X, Wang Y, Wang Y, Xu H. Comparison of polypropylene mesh and porcine-derived, cross-linked urinary bladder matrix materials implanted in the rabbit vagina and abdomen. Int Urogynecol J. 2014;25(5):683–9.CrossRefGoogle Scholar
  33. 33.
    Feola A, Abramowitch S, Jallah Z, Stein S, Barone W, Palcsey S, et al. Deterioration in biomechanical properties of the vagina following implantation of a high-stiffness prolapse mesh. BJOG. 2013;120(2):224–32.CrossRefGoogle Scholar
  34. 34.
    Mazza E, Ehret AE. Mechanical biocompatibility of highly deformable biomedical materials. J Mech Behav Biomed Mater. 2015;48:100–24.CrossRefGoogle Scholar
  35. 35.
    Mohammadi M, Dryden JR, Jiang L. Stress concentration around a hole in a radially inhomogeneous plate. Int J Solids Struct. 2011;48(3–4):483–91.CrossRefGoogle Scholar

Copyright information

© The International Urogynecological Association 2019

Authors and Affiliations

  1. 1.Department of Obstetrics and GynecologyPeking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical CollegeBeijingPeople’s Republic of China
  2. 2.Department of Obstetrics and GynecologyXuanwu Hospital, Capital Medical UniversityBeijingPeople’s Republic of China

Personalised recommendations