Dysregulated Wound Healing in the Pathogenesis of Urogynecologic Mesh Complications

Faculty from the UPMC Department of Obstetrics, Gynecology, and Reproductive Sciences including Amanda Artsen, MD (corresponding author); Rui Liang, MD; Leslie Meyn, PhD; Megan Bradley, MD; and Pamela Moalli, MD, PhD, recently published research in Scientific Reports that explored whether dysregulated wound healing is associated with urogynecologic mesh complications.

The team hypothesized that patients experiencing mesh complications would show signs of abnormal wound healing. They also believed that proteins suggestive of dysregulated extracellular matrix remodeling would be elevated in mesh complications, but with inflammatory markers showing similar levels between groups. 

Researchers collected vaginal cell secretions using vaginal swabs after polypropylene mesh implantation in 39 patients with complication and 40 patients without complication. A customized multiplex immunoassay, a biochemical test that measures the presence of substances in a solution using antibody-antigen reactions, measured markers of inflammation, neuroinflammation, angiogenesis, and matrix proteins between groups. Symptom questionnaires including visual analog scales for pelvic pain scores and Pelvic Floor Distress Inventory (PFDI-20) questionnaires – an assessment used to evaluate distress caused by the presence of pelvic floor dysfunction – were completed at enrollment and 6 months after removal.

Results showed that patients with mesh complications were on average nine years younger, heavier, and more likely to be ever-smokers compared to those without mesh complications. Additionally, patients with mesh complications were more likely to be on both systemic and vaginal estrogen therapy, have received a mid-urethral sling as compared to a prolapse mesh, and have a longer duration of implantation.

Most notably, patients with mesh complications were more likely to have high bFGF, fibronectin, thrombospondin 2, VEGF and TNF-β in vaginal secretions obtained in vaginal swabs at the time of mesh removal, all of which showed increased complications when compared to controls. In addition, patients with mesh complications were 6x as likely to be an ever-smoker.

Ultimately, that data provided evidence of dysregulated wound healing in mesh complications, verifying the research team’s hypothesis and providing additional direction for developing and evaluating new biomaterials to treat prolapse and incontinence. 

For additional details about this study, please visit PubMed to view the full research analysis.

Reference

Artsen AM, Liang R, Meyn L, Bradley MS, Moalli PA. Dysregulated wound healing in the pathogenesis of urogynecologic mesh complications. Sci Rep. 2023 Dec 5;13(1):21437. doi: 10.1038/s41598-023-48388-8. PMID: 38052928; PMCID: PMC10698181.