Orchestrating the host response Toward novel therapeutic strategies for pelvic floor disorders

Surgical treatment pelvic organ prolpase (POP) often involves implants to restore pelvic floor support, but conventional polypropylene meshes have been associated with long-term complications due to an adverse foreign body response and poor tissue integration. This thesis aims to improve the safety and effectiveness of pelvic floor implants while developing innovative methods to evaluate vaginal tissue health and treatment outcomes.
The first part focuses on biomaterial innovation for pelvic floor surgery. The studies demonstrate that bacterial colonization may contribute to mesh-related complications, emphasizing the importance of implant designs that reduce bacterial adhesion. Fully absorbable poly-4-hydroxybutyrate (P4HB) biomaterials promoted favorable fibroblast responses, enhanced collagen deposition, and supported tissue remodeling in vitro and in vivo. In addition, surface microtopography was shown to influence the foreign body response, highlighting its potential to improve implant integration.
The second part investigates Handheld Video Microscopy (HVM) as a non-invasive technique to assess vaginal microcirculation and epithelial thickness. HVM visualized vascular changes after prolapse surgery, identified individual differences in tissue perfusion, and accurately measured epithelial thickness using focal depth as a surrogate marker. It also effectively monitored the response to topical estrogen therapy in women with genitourinary syndrome of menopause, providing new insights into vaginal physiology and tissue regeneration.
Together, these findings contribute to the development of safer absorbable implants and demonstrate the potential of HVM as a non-invasive tool for evaluating pelvic floor physiology, tissue regeneration, and treatment response, while guiding the development and evaluation of future biomaterials.