Pitt bioengineer finds support for female pelvic floor research

PITTSBURGH (Feb. 25, 2020) … A paper published by Steven Abramowitch, associate professor of bioengineering at the University of Pittsburgh, was recently recognized by the editors of the Journal of Biomechanical Engineering (JBME) for exemplifying high quality and significant work (DOI: 10.1115/1.4041743). The article details complications associated with mechanical loads on synthetic mesh used in pelvic organ prolapse and will be listed as an Editors’ Choice paper in JBME’s Annual Special Issue February 2020. William Barone, a bioengineering graduate alumnus, contributed as first author on this paper.

Pelvic organ prolapse (POP) is a condition where the organs in the pelvis push against the vagina, creating a “bulge” that can extend outside of the body. It results from a weakening of the muscles and tissues that help support the pelvic organs. Despite the fact that 12.6 percent of women in the U.S. will undergo major surgery for POP by the age of 80,¹ most of the studies surrounding these devices were conducted as they are applied to hernias in the abdomen. According to recent research, pelvic floor applications using this technology seem to be more vulnerable to mesh-related complications.

Abramowitch’s research in the Swanson School of Engineering and the Center for Interdisciplinary Research in Female Pelvic Health uses experimental and computational methods to examine the mechanical behavior of mesh so that it can be optimized for the female pelvic floor environment. 

“The textile and structural properties of mesh have proven to be an important factor in its efficacy – particularly the pore size, which has shown to increase complications when less than 1mm in size,” said Abramowitch. “Even though these devices are widely used, the in vivo mechanical behavior of synthetic mesh is largely unknown, as is the impact of its mechanics on surrounding biological tissues.”

Though most vaginal mesh is developed with pore sizes large enough to minimize complications, researchers have recently discovered that mechanical loading significantly alters pore dimensions. While previous studies have looked at the effects of uniaxial loading, Abramowitch and his group are broadening research in this area by quantifying multiaxial loading. 

“Transvaginal meshes, which are most commonly associated with complications and have been recently banned from use in the United States, are fixed at multiple locations in the pelvis. This creates multi-directional forces that cause the mesh to change shape in specific regions,” he explained. “Interestingly, our simulations predict the locations where the most shape change occurs, and they happen to be consistent with the most common sites for complications. This gives us a great possible lead to better understanding the mechanisms that cause mesh complications.”

Abramowitch’s group developed an experimental model to quantify pore dimensions in response to clinically relevant mechanical forces and a computational model to simulate the mechanical behavior of transvaginal mesh in response to these forces. By developing these models, they will be able to examine a wide range of mechanical conditions, predict mesh behavior, and eventually optimize devices for the female pelvic floor.

This research recently led to a $2,500,000 award from the National Institutes of Health to create a novel repair device designed for the vagina that may improve outcomes in POP surgery. Abramowitch and Pamela Moalli, professor of obstetrics, gynecology, and reproductive sciences at Pitt and pelvic reconstructive surgeon at UPMC Magee-Womens Hospital, will lead this effort.

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This work was funded by grants from the National Institutes of Health (R01 HD-045590, K12HD-043441) and the National Science Foundation Graduate Research Fellowship (DGE-0753293).

¹ 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. Epub 2014/05/09. doi: 10.1097/AOG.0000000000000286. PubMed PMID: 24807341; PubMed Central PMCID: PMCPMC4174312.