The limits of support From complication management toward safe implant surgery for pelvic organ prolapse and stress urinary incontinence

This thesis addresses the ongoing clinical challenges surrounding pelvic floor disorders, specifically pelvic organ prolapse and stress urinary incontinence. While traditional permanent mesh implants can effectively relieve symptoms, they carry a risk of severe, long-term complications. Consequently, we focused on improving management of mesh-related complications, understanding reported systemic reactions, and evaluating safer, fully absorbable alternative treatments.
To improve care for patients suffering from local mesh complications, surgical revision or removal of implants was evaluated. The findings demonstrate that revision surgery successfully relieves symptoms in most cases. Notably, performing revision surgery years after the initial procedure remains highly effective, indicating that healthcare providers should not hesitate to intervene even when complications have a late onset. In addition, to address growing concerns regarding systemic complaints, a diagnostic protocol combining immunological testing and skin allergy responses was established to clarify whether polypropylene meshes can trigger a true autoimmune reaction.
Beyond managing complications, this thesis explores innovative, fully absorbable materials that serve as temporary scaffolds. Preclinical evaluations showed that P4HB materials promote natural tissue regeneration and host-tissue integration without requiring oestradiol additives. Furthermore, early clinical testing of a novel absorbable mid-urethral sling confirmed its safety and efficacy, offering a viable alternative to permanent synthetic implants.
Finally, when comparing traditional sling surgery to less invasive options like urethral bulking agents, sling procedures proved to be significantly more effective and considerably safer. Bulking agents led to higher complication rates and material exposure, reinforcing that sling surgery remains the superior treatment choice for long-term patient outcomes.