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UPMC Magee OB/GYN Department Appoints New Director of Urogynecology Division

October 9, 2019

Pamela Ann Moalli, MD, PhD, has been appointed as the new director of the Division of Urogynecology and Pelvic Reconstructive Surgery in the Department of Obstetrics, Gynecology, and Reproductive Sciences at the University of Pittsburgh School of Medicine and UPMC Magee-Womens Hospital. Dr. Moalli was promoted to the division director position and Halina Zyczynski, MD, the former director has assumed the role of medical director of Magee-Womens Specialty Services at UPMC Hamot in Erie, Pennsylvania.

Dr. Moalli

Dr. Moalli holds the appointments of professor in both the Department of Obstetrics, Gynecology, and Reproductive Sciences and the Department of Bioengineering, along with secondary appointments as an associate professor at the University of Pittsburgh's McGowan Institute for Regenerative Medicine and the Clinical and Translational Science Institute. Additionally, Dr. Moalli serves as fellowship director for the Female Pelvic Medicine and Reconstructive Surgery Program.

Dr. Moalli earned her doctorate in molecular and cellular biology and her medical degree from Northwestern University as part of its NIH-sponsored Medical Scientist Training Program. She then completed both her obstetrics and gynecology residency and fellowship in urogynecology and reconstructive pelvic surgery at the University of Pittsburgh and UPMC Magee, where she joined the faculty as an assistant professor immediately after completing fellowship training in 2000.

In 2004, Dr. Moalli became the director of translational research in the Division of Urogynecology and Reconstructive Pelvic Surgery, followed by appointment as director of the in Female Pelvic Medicine and Reconstructive Surgery fellowship in 2006.  In 2007, she was promoted to associate professor in the Department of Obstetrics, Gynecology, and Reproductive Sciences, and in 2016 was named a full professor with tenure in the Department.

Research Focus and Contributions to Science

A distinguished basic science researcher, clinician, and educator, Dr. Moalli and her collaborators operate one of only a few research programs and laboratories in the country that use a laboratory-based approach to study the pathogenesis of pelvic floor disorders, particularly in the context of severe maternal birth injury. In addition, Dr. Moalli has established herself as a national and international leader in biomaterials used to repair pelvic organ prolapse, employing state-of-the-art technology that includes computational models developed by her research group that are providing insights into the mechanisms by which commonly performed surgeries fail to improve patient outcomes.

The primary focus of Dr. Moalli’s research has been on prolapse meshes, first defining their impact on the vagina and then transitioning to studying mechanisms of complications. Based on this knowledge, her group is currently working to develop novel, elastomeric meshes with biomechanical properties that more closely match those of the native tissue of the vagina. More recently, she has explored regenerative techniques to rebuild compromised vaginal supportive tissues. The strength of her research group is that it is highly interdisciplinary with expertise in biochemistry, biomechanics, computational analyses, and biomaterials. 

The Center for Interdisciplinary Research in Female Pelvic Health (CIRPH)

Dr. Moalli co-directs the Center with Steven Abramowitch, PhD. The CIRPH is engaged in collaborative studies designed to contribute insights into the pathogenesis, diagnosis, and treatment of pelvic organ prolapse and urinary incontinence. The Center’s research priorities primarily focus on the use of biomaterials in urogynecologic procedures, defining mechanisms of failure after reconstructive pelvic surgeries and elucidating the mechanisms of maternal birth injury. Dr. Moalli and her research collaborators have collective expertise in cellular and molecular biology, including both traditional and high throughput platforms, soft tissue mechanics, mechanobiology, tissue regeneration, and immunomodulation. 

New NIH R01 to Develop Novel Prolapse Device

Dr. Moalli’s latest NIH-funded R01 grant, obtained in April 2019, is a five-year, $2.5 million award that will fund research designed to overcome complications of polypropylene prolapse meshes through the development of novel elastomeric auxetic devices. Dr. Moalli’s group seeks to develop a new device designed specifically for the vagina that has high potential to markedly improve the outcomes of prolapse surgeries while minimizing complications. 

Leading Research Into Synthetic Materials for Urogynecologic Applications

Dr. Moalli and her research team are international leaders in studies defining the impact of commonly used urogynecologic meshes on the vagina (histomorphologic, biochemical, and mechanical endpoints) in animal models (primate) and women, modifying the host response to improve long-term outcomes, and developing meshes that are designed specifically for the material properties of the vagina (current materials are simply hernia meshes remarketed for prolapse surgery as 510K devices). In ex vivo mechanical tests in conjunction with computational analyses, Dr. Moalli’s group has clearly demonstrated that prolapse meshes often have markedly unstable geometries with a dramatic loss of porosity with small applications of tension, and that the stresses imposed on the vagina by the mesh have significant regional variability. These effects are driven mainly by modifiable factors, including the pore geometry of the mesh, the degree of tension, and how the mesh is anchored. Indeed, the group's experimental and computational model predictions of the impact of these mechanical effects are confirmed in mesh explants removed from women with mesh complications that demonstrate buckles, folds, and pore collapse. Using ex vivo mechanical tests in conjunction with animal models and computational analyses, the group previously demonstrated that most mesh used for incontinence and prolapse surgery has unstable geometries with a loss of porosity under modest tension. They hypothesize that this is a mechanism for complications (exposures and visceral erosions). The group is currently developing a new generation of meshes based on elastomeric polymers and stable geometries as an alternative to current polypropylene meshes, which plastically deform when loaded. In addition, they are working towards personalized meshes based on 3D modeling of an individual patient's vagina and specific support defects with the idea that it is unlikely that a single mesh type and geometry is an appropriate match for all women with prolapse. 

Educational Priorities

In addition to her research and clinical efforts, Dr. Moalli is extensively involved in teaching college and medical students, graduate students, residents, and clinical fellows. Her greatest teaching commitment is to the fellows in the Female Pelvic Medicine and Reconstructive Surgery Program at the University of Pittsburgh. As director of the program, she is responsible for ensuring that the fellows have the appropriate training as clinicians, surgeons, and researchers to rise to the top of their field.

After assuming the role of director of the fellowship program in 2006, Dr. Moalli reorganized the program to provide comprehensive, integrated training in urogynecology, urology, gastroenterology, and colorectal surgery, ultimately achieving full ACGME certification of the program in 2014.

Further Reading

Knight KM, Artsen AM, Routzong MR, King GE, Abramowitch SD, Moalli PA. New Zealand White Rabbit: A Novel Model for Prolapse Mesh Implantation Via a Lumbar Colpopexy. Int Urogynecol J. 2019 Aug 15. doi: 10.1007/s00192-019-04071-z. Epub ahead of print.

Artsen AM, Rytel M, Liang R, King GE, Meyn L, Abramowitch SD, Moalli PA. Mesh Induced Fibrosis: The Protective Role of T Regulatory Cells. Acta Biomater. 2019 Sep 15; 96: 203-210. doi: 10.1016/j.actbio.2019.07.031. Epub 2019 Jul 19.

Routzong MR, Moalli PA, Maiti S, De Vita R, Abramowitch SD. Novel Simulations to Determine the Impact of Superficial Perineal Structures on Vaginal Delivery. Interface Focus. 2019 Aug 6; 9(4): 20190011. doi: 10.1098/rsfs.2019.0011. Epub 2019 Jun 14.

Shaffer RM, Liang R, Knight K, Carter-Brooks CM, Abramowitch S, Moalli PA. Impact of Polypropylene Prolapse Mesh on Vaginal Smooth Muscle in Rhesus Macaque. Am J Obstet Gynecol. 2019 May 16. pii: S0002-9378(19)30666-0. doi: 10.1016/j.ajog.2019.05.008. Epub ahead of print.

Tennyson L, Rytel M, Palcsey S, Meyn L, Liang R, Moalli P. Characterization of the T-cell Response to Polypropylene Mesh in Women With Complications. Am J Obstet Gynecol. 2019 Feb; 220(2): 187.e1-187.e8. doi: 10.1016/j.ajog.2018.11.121. Epub 2018 Nov 9.

Barone WR, Knight KM, Moalli PA, Abramowitch SD. Deformation of Transvaginal Mesh in Response to Multiaxial Loading. J Biomech Eng. 2019 Feb 1; 141(2). doi: 10.1115/1.4041743.

Carter-Brooks CM, Zyczynski HM, Moalli PA, Brodeur PG, Shepherd JP. Early Catheter Removal After Pelvic Floor Reconstructive Surgery: A Randomized Trial. Int Urogynecol J. 2018 Aug; 29(8): 1203-1212. doi: 10.1007/s00192-018-3641-3. Epub 2018 Mar 29.

Knight KM, Moalli PA, Abramowitch SD. Preventing Mesh Pore Collapse by Designing Mesh Pores With Auxetic Geometries: A Comprehensive Evaluation Via Computational Modeling.
J Biomech Eng. 2018 May 1; 140(5).

Siddiqui NY, Gregory WT, Handa VL, DeLancey JOL, Richter HE, Moalli P, Barber MD, Pulliam S, Visco AG, Alperin M, Medina C, Fraser MO, Bradley CS. American Urogynecologic Society Prolapse Consensus Conference Summary Report. Female Pelvic Med Reconstr Surg. 2018 Jul/Aug; 24(4): 260-263.

Berger AA, Abramowitch S, Moalli PA. 3D Vascular Anatomy of the Presacral Space: Impact of Age and Adiposity. Int Urogynecol J. 2019 Mar; 30(3): 401-407.

Oliphant S, Canavan T, Palcsey S, Meyn L, Moalli P. Pregnancy and Parturition Negatively Impact Vaginal Angle and Alter Expression of Vaginal MMP-9. Am J Obstet Gynecol. 2018 Feb; 218(2): 242.e1-242.e7. doi: 10.1016/j.ajog.2017.11.572. Epub 2017 Nov 16.

Knight K, Moalli P, Abramowitch SD. Preventing Mesh Pore Collapse by Designing Mesh Pores with Auxetic Geometries: A Comprehensive Evaluation via Computational Modeling. J Biomech Eng. 2018 Jan 19. doi: 10.1115/1.4039058. Epub ahead of print.

Liang R, Knight K, Easley D, Palcsey S, Abramowitch S, Moalli PA. Towards Rebuilding Vaginal Support Utilizing an Extracellular Matrix Bioscaffold. Acta Biomater. 2017; 57: 324-333. 

Liang R, Knight K, Barone W, Powers RW, Nolfi A, Palcsey S, Abramowitch S, Moalli PA. Extracellular Matrix Regenerative Graft Attenuates the Negative Impact of Polypropylene Prolapse Mesh on Vagina In Rhesus Macaque. Am J Obstet Gynecol. 2017 Feb; 216(2): 153.e1–153.e9. Published online 2016 Sep 8. 

Nolfi A, Brown BN, Liang R, Palcsey SL, Bonidie MJ, Abramowitch SD, Moalli PA. Host Response to Synthetic Mesh in Women With Mesh Complications. Am J Obstet Gynecol. 2016 Aug; 215(2): 206.e1-8. 

Barone WR, Moalli PA, Abramowitch SD. Textile Properties of Synthetic Prolapse Mesh in Response to Uniaxial Loading. Am J Obstet Gynecol. 2016 Mar 18; Epub ahead of print.

Barone WR, Amini R, Maiti S, Moalli PA, Abramowitch SD. The Impact of Boundary Conditions on Surface Curvature of Polypropylene Mesh in Response to Uniaxial Loading. J Biomech. 2015 Jun 25; 48(9): 1566-1574.

Brown BN, Mani D, Nolfi AL, Liang R, Abramowitch SD, Moalli PA. Characterization of the Host Inflammatory Response Following Implantation of Prolapse Mesh in Rhesus Macaque. Am J Obstet Gynecol. 2015 Nov; 213(5): 668.e1-668.e10.

Liang R, Zong W, Palcsey S, Abramowitch S, Moalli P. Impact of Prolapse Meshes on the Metabolism of Vaginal Extracellular Matrix in Rhesus Macaque. Am J Obstet Gynecol. 2015. 212(2): 174.e1-7.