**Author details**

and configurations. With respect to choice of materials for POP we have suggested a biodegradable material, poly-L-lactic acid (PLA). This is a polymer of lactic acid which is among the most commonly used polymers in biomedical applications [68]. For a biomaterial to treat stress urinary incontinence (SUI) we have selected a nondegradable polymer of polyurethane Z3-as this

PLA is highly biocompatible and as a degradable polymer it is commonly used as a drug delivery material [69]. In one of our first studies with a biodegradable PLA scaffold produced using the electrospinning technique we showed that the material was extensively infiltrated by host cells together with new collagen deposition and new blood vessel formation after 7 days of implantation into the rat abdomen [70]. We than tried to mimic the organization of the natural extracellular matrix by spinning transversely, obliquely and irregularly aligned PLA electrospun fibers. Here we sought to achieve the viscoelastic mechanical properties of native fascia. We confirmed that MSC cells would grow on these fibers and produce new extracellular matrix. This allowed us to report in 2016 that electrospun scaffolds with several layers of different polymers to achieve the desired biomechanical properties of native fascia [71] maintained good mechanical integrity, compared to PPL meshes, over 90 days following implantation using a rabbit model [50]. The host response to these multi-layered PLA scaffolds was characterized as a predominantly M2

is not the subject of this chapter this will not be discussed further in this review.

(remodeling) type 30 and 90 days after implantation onto the abdomen of the rabbit.

Another crucial requirement to achieve a rapid integration into host issues is related to vascular supply in and around the biomaterial. This can be particularly concerning in cases where the wound bed is already poorly vascularized, such as pelvic floor tissues of postmenopausal women with SUI and POP [72]. The growth of new blood vessels into a tissue engineered substitute is crucial to improve its' tissue integration and to obtain a successful long term clinical outcome. It has been estimated that a distance of less than 200 μM from the supplying capillary is the critical distance for diffusion of oxygen and nutrients to any new tissue introduced into the body. Because of this, the survival of any three-dimensional tissue graft relies on rapid development of new blood vessels to supply not only the center but also the margins of the graft [73].

Accordingly we have explored the introduction of clinically acceptable agents (specifically ascorbic acid and estradiol) that would stimulate neovascularisation and new extra cellular matrix production by the patient's endogenous cells. To this end we have demonstrated effective pharmacological functionalization of electrospun PLA scaffolds by incorporating ascorbic acid into them to stimulate ECM production without compromising mechanical properties [74]. We have also recently described an estradiol releasing, biocompatible mesh of electrospun PLA which doubled the number of blood vessels in and around the mesh when tested *in vivo* [75].

Polypropylene based vaginal meshes were never designed or tested specifically for use in the pelvic floor. The complications associated with the use of these vaginal mesh implants are largely due to a poor choice of material. A basic understanding of the material properties in relation to the physiological requirements of the site of implantation is essential for those developing and evaluating materials to assist surgeons seeking to repair the weakened pelvic floor.

**8. Conclusion**

46 Pelvic Floor Disorders

Naşide Mangir1,2, Christopher R. Chapple2 and Sheila MacNeil<sup>1</sup> \*

\*Address all correspondence to: s.macneil@sheffield.ac.uk

1 Department of Material Science and Engineering, Kroto Research Institute, University of Sheffield, UK

2 Department of Urology, Royal Hallamshire Hospital, Sheffield, UK

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2018]

54 Pelvic Floor Disorders


**Chapter 5**

**Provisional chapter**

**Recurrent Pelvic Organ Prolapse**

**Recurrent Pelvic Organ Prolapse**

DOI: 10.5772/intechopen.76669

The treatment of recurrent pelvic organ prolapse is challenging. The pelvic floor symptom needs to be treated, a high quality of life has to be ensured and complications have to be minimized. There is a wide range of surgical options that may be used. The surgeon should be able to discuss and offer native tissue procedures for prolapse. In addition, for the clinically challenging situations of recurrent prolapse, mesh augmented procedures may need to be discussed with the patient. A thorough knowledge of mesh and graft options, as well as knowledge of prolapse recurrence and adverse events rate, can help guide clinicians in counseling their patients effectively. Ultimately, this will allow surgeons to choose a personalized treatment option that best align with a woman's lifestyle and treatment goals. In this chapter the anatomical concepts of supports of vagina are elaborated. The pelvic diaphragm, lateral attachment of vagina to arcus tendineus fascia pelvis, intrinsic and extrinsic sphincter control mechanisms are elaborated. The surgical techniques of suspending the vaginal vault with autologous tissue and synthetic mesh are discussed. Finally, the role of minimally invasive surgery of pelvic floor is discussed

as an integral part of management of recurrent vaginal prolapse.

**Keywords:** recurrent POP, pelvic floor, perineum, prolapse, vaginal vault prolapse,

Vaginal prolapse can be studied in defects at three levels of Prof John Delancey (**Figure 1**).

Usually vault prolapse is associated with anterior and/or posterior wall prolapse. The anterior compartment, the central compartment and the posterior compartment defect. Anterior compartment consists of the bladder and urethra. The central compartment consists of the vaginal vault/uterus. The rectum and perineal body form the posterior compartment. The lateral

> © 2016 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

© 2018 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use,

distribution, and reproduction in any medium, provided the original work is properly cited.

Nidhi Sharma and Sudakshina Chakrabarti

Nidhi Sharma and Sudakshina Chakrabarti

Additional information is available at the end of the chapter

Additional information is available at the end of the chapter

http://dx.doi.org/10.5772/intechopen.76669

**Abstract**

sacrospinous fixation

**1. Introduction**

#### **Recurrent Pelvic Organ Prolapse Recurrent Pelvic Organ Prolapse**

Nidhi Sharma and Sudakshina Chakrabarti Nidhi Sharma and Sudakshina Chakrabarti

Additional information is available at the end of the chapter Additional information is available at the end of the chapter

http://dx.doi.org/10.5772/intechopen.76669

#### **Abstract**

The treatment of recurrent pelvic organ prolapse is challenging. The pelvic floor symptom needs to be treated, a high quality of life has to be ensured and complications have to be minimized. There is a wide range of surgical options that may be used. The surgeon should be able to discuss and offer native tissue procedures for prolapse. In addition, for the clinically challenging situations of recurrent prolapse, mesh augmented procedures may need to be discussed with the patient. A thorough knowledge of mesh and graft options, as well as knowledge of prolapse recurrence and adverse events rate, can help guide clinicians in counseling their patients effectively. Ultimately, this will allow surgeons to choose a personalized treatment option that best align with a woman's lifestyle and treatment goals. In this chapter the anatomical concepts of supports of vagina are elaborated. The pelvic diaphragm, lateral attachment of vagina to arcus tendineus fascia pelvis, intrinsic and extrinsic sphincter control mechanisms are elaborated. The surgical techniques of suspending the vaginal vault with autologous tissue and synthetic mesh are discussed. Finally, the role of minimally invasive surgery of pelvic floor is discussed as an integral part of management of recurrent vaginal prolapse.

DOI: 10.5772/intechopen.76669

**Keywords:** recurrent POP, pelvic floor, perineum, prolapse, vaginal vault prolapse, sacrospinous fixation
