gms | German Medical Science

Introduction: It is well known that pelvic organ prolapse significantly reduces the quality of life of affected women and in many cases requires corrective surgery. This surgery was refined. Optimized titanized polypropylene mesh TiLOOP^® PRO A has already shown a significant improvement in quality-of-life following implantation of the mesh for surgical correction of a cystocele. In the past, the PROLIFT™ pelvic floor repair system was also used intensively. This system used a pre-cut, nonabsorbable monofilament of polypropylene, not coated with titanium.

Methods: Within this study we analyzed mesh surgery side effects in a large cohort of prolapse corrective surgery. In addition, we analyzed the influx of CD68- & CD163-positive macrophages in patients of non-titanized polypropylene mesh removal after infectious/non-infectious complications. Furthermore, we developed an in vitro model for a comparative analysis of macrophage activation by titanized- and non-titanized polypropylene mesh material.

Results: Non-titanized polypropylene mesh developed several complications. In addition, we saw macrophage activation and PD-L1 expression in macrophages surrounding non-titanized polypropylene mesh material. Results of the in vitro study showed that only human fibroblast covered non-titanized polypropylene mesh material induced a specific macrophage polarization reaction. Specifically, CD68-positive macrophages co-expressing PD-L1 were found.

Conclusion: These findings suggest that polypropylene mesh erosion is accompanied with macrophage influx and immune checkpoint molecule expression.

Conflict of interest: C.D. is funded by Roche, AstraZeneca, TEVA, Mentor, MCI Healthcare. F.P.: Consulting – pfm medical. All other authors declare no conflict of interest.