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Development and Evaluation of Auxetic Meshes for Pelvic Organ Prolapse Repair

Knight, Katrina (2017) Development and Evaluation of Auxetic Meshes for Pelvic Organ Prolapse Repair. Doctoral Dissertation, University of Pittsburgh. (Unpublished)

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Abstract

Pelvic organ prolapse (prolapse) is a gynecologic condition that negatively impacts half of all women over the age of 50. It is characterized by the unnatural descent of the pelvic organs into the vaginal canal. Synthetic mesh, commonly used in the treatment of prolapse, is associated with complications, which prompted the FDA to release public health notifications in 2008 and 2011. Research suggests that pore collapse, material stiffness mismatches with vaginal tissue, increased mesh burden, and meshes experiencing permanent deformation with loading all potentially contribute to mesh complications. Thus, the overall goal of this dissertation was to develop an initial prototype mesh that overcomes the problems with current meshes. To accomplish this goal, the behavior of computational, mesh models, with varying auxetic pore geometries, in response to simulated uniaxial loading was assessed via finite element analysis (FEA). Results demonstrated that certain auxetic geometries can prevent pore collapse; however, pore expansion is dependent on the orientation of the auxetic geometry (i.e. the pore) with respect to the loading direction. Next, meshes with auxetic geometries for pores were manufactured from a soft, elastomer polydimethylsiloxane (PDMS), which had a material stiffness that is similar to that of the vagina. The behavior of these meshes was characterized via mechanical testing. Similar to the FEA results, the pores of the mesh expanded in response to tensile loading, and this behavior was dependent on the orientation of the pore. Additionally, pore expansion was associated with a decrease in mesh burden, and meshes did not permanently deform in response to cyclic loading. Lastly, the host response to elastomeric meshes was assessed via implantation into the abdomens of rodents for 35 days. The default host response to a foreign material was observed with an absence of bridging fibrosis, a phenomenon associated with encapsulation, mesh contraction, and pain. Additionally, the fibrotic response to the elastomeric meshes was less than that of the prototype prolapse mesh, Gynemesh PS. Overall, a novel synthetic mesh was developed which has the potential to improve the current design of prolapse meshes and decrease the risk of mesh related complications.


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Details

Item Type: University of Pittsburgh ETD
Status: Unpublished
Creators/Authors:
CreatorsEmailPitt UsernameORCID
Knight, Katrinakmk144@pitt.edukmk144
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Committee ChairAbramowitch, Steven Dsdast9@pitt.edusdast9
Committee MemberBrown, Bryanbrownb@upmc.edu
Committee MemberBrigham, John Cbrigham@pitt.edubrigham
Committee MemberMoalli, Pamela Amoalpa@mail.magee.edu
Committee MemberWang, Yadongyaw20@pitt.eduyaw20
Date: 14 June 2017
Date Type: Publication
Defense Date: 27 March 2017
Approval Date: 14 June 2017
Submission Date: 6 April 2017
Access Restriction: 5 year -- Restrict access to University of Pittsburgh for a period of 5 years.
Number of Pages: 330
Institution: University of Pittsburgh
Schools and Programs: Swanson School of Engineering > Bioengineering
Degree: PhD - Doctor of Philosophy
Thesis Type: Doctoral Dissertation
Refereed: Yes
Uncontrolled Keywords: pelvic organ prolapse, synthetic mesh, vagina
Date Deposited: 14 Jun 2017 16:02
Last Modified: 14 Jun 2017 16:02
URI: http://d-scholarship.pitt.edu/id/eprint/31308

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