3D-Printed Medical-Grade Polycaprolactone (mPCL) Scaffold for the Surgical Treatment of Vaginal Prolapse and Abdominal Hernias.

The expected outcome after a scaffold augmented hernia repair is the regeneration of a tissue composition strong enough to sustain biomechanical function over long periods. It is hypothesised that melt electrowriting (MEW) medical-grade polycaprolactone (mPCL) scaffolds loaded with platelet-rich plasma (PRP) will enhance soft tissue regeneration in fascial defects in abdominal and vaginal sheep models. A pre-clinical evaluation of vaginal and abdominal hernia reconstruction using mPCL mesh scaffolds and polypropylene (PP) meshes was undertaken using an ovine model. Each sheep was implanted with both a PP mesh (control group), and a mPCL mesh loaded with PRP (experimental group) in both abdominal and vaginal sites. Mechanical properties of the tissue-mesh complexes were assessed with plunger tests. Tissue responses to the implanted meshes were evaluated via histology, immunohistochemistry and histomorphometry. At 6 months post-surgery, the mPCL mesh was less stiff than the PP mesh, but stiffer than the native tissue, while showing equitable collagen and vascular ingrowth when compared to PP mesh. The results of this pilot study were supportive of mPCL as a safe and effective biodegradable scaffold for hernia and vaginal prolapse repair, hence a full-scale long-term study (over 24-36 months) with an adequate sample size is recommended.

The minimal important difference of the Australian Pelvic Floor Questionnaire.

INTRODUCTION AND HYPOTHESIS: The aim of this study was to establish the minimal important difference (MID) of the Australian Pelvic Floor Questionnaire (APFQ) in women undergoing surgery for stress urinary incontinence or symptomatic pelvic organ prolapse. A further aim was to estimate dysfunction scores dependent on the bothersomeness in a community cohort. METHODS: The APFQ was completed before and 6 weeks after pelvic floor surgery by 183 women (n = 80 suburethral tape insertion; n = 103 laparoscopic sacrocolpopexy). Distribution and anchor-based methods were used to establish the effect size, standardised response mean and MID (calculated as the difference between women who stated no change or a little better in the Patient Global Impression of Improvement [PGI-I]). In a community cohort of 470 women aged 42-80 years, the APFQ was analysed according to disclosed bothersomeness. RESULTS: For the suburethral tape group, the effect size in the bladder domain was 1.5 and the PGI-I-based MID 1.3. For the POP surgery, group the effect size in the prolapse domain was calculated at 2.2 and the PGI-I-based MID at 1.0. The domain scores for women who declared no bother were significantly different from those who were a little bothered (bladder domain 2.2 vs 4.0, bowel 0.6 vs 1.7, POP 0.1 vs 3.2, sex 1.8 vs 3.0) with wide variations. CONCLUSIONS: The MID of the APFQ ranged from 1.0 to 1.3 in the domains after POP or continence surgery respectively. This is corroborated by the differences in domain scores from community-based women who were bothered versus not bothered by pelvic floor symptoms.

Infusion-fill method versus standard auto-fill trial of void protocol following a TVT-exact procedure: A randomised controlled trial.

OBJECTIVE: To establish whether the infusion method trial of void (TOV) after a mid-urethral sling procedure, in contrast to the standard auto-fill TOV, permits discharge home from recovery, as these procedures are eminently suited to same day discharge, and the delay in achieving a successful TOV often keeps the patient in hospital overnight. METHOD: A randomised controlled trial performed between December 2014 and April 2016 at the University Hospital, enrolling 40 women undergoing a mid-urethral sling procedure for stress urinary incontinence. The women were randomised to infusion method or auto-fill method TOV. The primary outcome was discharge home from the recovery area of theatre. RESULTS: Discharge from recovery was not different between the two groups (odds ratio (OR) 1.3 95% CI: 0.3-5.9, P = 0.71). The rate of TOV being successfully passed in recovery was higher in the infusion-fill group compared to the standard auto-fill group (OR 4.5 95% CI 1.2-17.4, P = 0.025). This means that three women will undergo the infusion-fill to achieve one more successful TOV in recovery. CONCLUSIONS: The infusion method resulted in more women passing their TOV in recovery but this did not translate into more discharges from recovery.