# Overcoming Complications of Polypropylene Prolapse Meshes:  Development of Novel Elastomeric Auxetic Devices

> **NIH NIH R01** · MAGEE-WOMEN'S RES INST AND FOUNDATION · 2020 · $527,629

## Abstract

PROJECT SUMMARY
Pelvic organ prolapse (POP) is a common, costly condition in women with a lifetime risk of surgical repair of
12.6%. Of those undergoing a native tissue repair, 40% will fail by 2 years prompting surgeons to turn to
biomaterials, most commonly polypropylene mesh. Unfortunately, POP meshes are abdominal hernia meshes
that have been remarketed under 510K applications for POP repair and, thus, were never designed specifically
for the vagina. Our studies show that implantation with polypropylene mesh leads to degeneration, atrophy
and loss of function of the vagina. The high material stiffness of polypropylene dictates that meshes
manufactured from this polymer are knitted, leading to a device that undergoes pore collapse, wrinkling, and
permanent deformation -- all contributing to increased mesh burden, a heightened foreign body response, and
poor outcomes. We hypothesize that a mesh generated from an elastomeric polymer with a material
stiffness on the same order of magnitude as that of the vagina, a geometry that favors stable pores,
and minimal wrinkling with tensioning will be associated with a more favorable host response than
current polypropylene prolapse meshes. Here we are proposing to develop and evaluate a mesh
synthesized from polycarbonate-urethane (PCU), an elastomer with an inherent stiffness similar to that of
vagina but that is also sufficiently tough to meet physiologic loading demands. The mesh is designed with
auxetic pores; meaning they expand instead of contract with loading. In addition, the mesh can be 3D printed,
permitting us to fine tune the in-plane geometry and thickness, and allow for non-rotational junctions, thereby
reducing wrinkling and permanent deformation. Specifically, our goal in this application is to delineate the
impact of our choice for the stiffness of PCU on the host response to the mesh because this choice will impact
the amount of material necessary to achieve structural support and strength equivalent to that of polypropylene
mesh. The amount of material contributes directly to the magnitude of the host response, but can also obviate
or enhance mechanical behaviors, e.g. wrinkling, in the device that feedback into the host response. Thus, in
moving this device forward for eventual use in humans, we will study how our design choices independently
impact the host response to the material and the mechanics of the mesh by: (Aim 1) implanting small units of
the mesh with varied material stiffness, fiber width and mesh thickness on the vagina without tensioning and
loading, and (Aim 2) utilizing computational modeling and ex vivo tests to determine the impact of the same
design choices on the mechanical behavior of the full length mesh with loading. In Aim 3, we will study how
choices that balance the host response to the material with those resulting from the mechanics of the mesh
collectively contribute to the overall host response to a mesh that is implanted on tension by sacrocolpopexy in...

## Key facts

- **NIH application ID:** 9917810
- **Project number:** 5R01HD097187-02
- **Recipient organization:** MAGEE-WOMEN'S RES INST AND FOUNDATION
- **Principal Investigator:** STEVEN D ABRAMOWITCH
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $527,629
- **Award type:** 5
- **Project period:** 2019-04-17 → 2024-03-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9917810

## Citation

> US National Institutes of Health, RePORTER application 9917810, Overcoming Complications of Polypropylene Prolapse Meshes:  Development of Novel Elastomeric Auxetic Devices (5R01HD097187-02). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/9917810. Licensed CC0.

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