For millions of women, pelvic organ prolapse is life altering in painful and embarrassing ways. Promising research at Magee-Womens Research Institute (MWRI) has the potential to change the lives of women throughout the world who suffer from this condition.

Pelvic prolapse results from the weakening of the vaginal walls supporting a woman’s bladder, uterus, small bowel and rectum. It can cause women to withdraw from normal activities due to pelvic pain, incontinence and other issues. Childbirth, age and heredity are contributing factors.

Pamela Moalli, MD, PhD

“About 12.6 percent of women [nearly one in eight] will have a major surgery to repair prolapse by the time they reach age 80,” says Pamela Moalli, MD, PhD, pelvic reconstructive surgeon and investigator for MWRI. “This is an extremely disabling problem affecting more and more women as our population ages.”

For more than a dozen years, Dr. Moalli has pursued solutions to help women with prolapse. As a surgeon, she has successfully applied the latest prolapse repair techniques. As a researcher, she is pushing the envelope toward the next major breakthrough.

“So many women whom I’ve treated have come back and tearfully thanked me for giving them their life back,” Dr. Moalli continues. “When your organs are falling out between your legs, you have urinary leakage and urgency, pressure, difficulties with sex and social isolation, and you can get back your normal anatomy — it’s very life changing and impactful.”

Meshing Medicine with Bioengineering

The breakthrough Dr. Moalli hopes to bring about is in improving the surgical mesh currently used to support the walls of the prolapsed vagina. It’s now made from polypropylene, a strong but flexible type of plastic. Well-established as safe for hernia repairs, the material gained quick approval for use with pelvic prolapse.

Steven Abramowitch, PhD

Yet, Dr. Moalli is convinced that better materials can be found for use in the pelvic floor. She points out that the polypropylene mesh creates complications in 10 to 30 percent of women. “We don’t want to rely on a surgeon’s ability to adapt to deficiencies in the material,” she states

Bringing the issue to MWRI bioengineer Steven Abramowitch, PhD, and his research lab, Dr. Moalli is determined to find a lighter weight, more elastic material that is easier to implant and integrate with the tissues of the vagina.

Until meeting Dr. Moalli, Dr. Abramowitch had focused his research on orthopedics and sports medicine. “Dr. Moalli approached me with the idea of doing research for pelvic organ prolapse,” he says. “It’s not something people want to talk about, and I had no idea it existed. When she took me to see some of her patients who have been helped by surgical mesh, it was very moving to see the impact this can have on their lives.”

Since 2003, he has focused his engineering skills on solutions for pelvic floor disorders, and he hopes this latest quest for a light-weight, elastic mesh—called an elastomeric polymer—can successfully resolve pelvic organ prolapse.

 Progress in the Laboratory

Dr. Abramowitch and Katrina Knight, PhD, are creating complex computer models in their lab that simulate potential materials for pelvic floor mesh. The computer allows engineers to explore different materials without having to manufacture each type. They want a mesh that’s durable enough to move with a woman and bear the weight of her organs when she stands and resilient enough to return to its former shape following sudden movements.

“An elastomer is like a rubber band, which returns to its initial shape after you pull it,” Dr. Abramowitch explains. “Current meshes being used are more likely to stay in that pulled state and cause the pores of the mesh to collapse. We want to prevent that so there’s an opportunity for normal tissue to grow into the pores.”

He says finding the right mesh material and pore shape for the vaginal tissue to integrate with and sink into is much like helping the tissue lie on a soft, comfortable bed versus lying on hard pavement.

Another goal is to find mesh that can be implanted transvaginally—through the vagina—without incisions. Prolapse surgery typically is performed with robotic-assisted surgery or laparoscopy, using small incisions in the abdomen and tiny cameras and surgical instruments inserted through those incisions. The transvaginal approach would transform the procedure from minimally invasive to noninvasive.

After the team pinpoints the best mesh material, the mesh device will be put through rigorous testing in animal models. If all goes well at that level, the research will progress to clinical trials with women and eventually find its way to market with Food and Drug Administration approval.

The research team keeps all options open, pursuing different avenues of research. Dr. Abramowitch notes that they are also investigating stem cells as a means of encouraging a patient’s own tissues to regenerate. This new direction would require even more extensive research and regulation than the mesh. It may not be needed if the new mesh works out as well as investigators hope.

Ongoing Commitment to Improving Women’s Health

“Very few bioengineering departments across the country have focused on female pelvic health, particularly pelvic organ prolapse,” Dr. Abramowitch says. He attributes the strong collaboration of engineering and medicine, in part, to the physical proximity of the medical school and bioengineering school at the University of Pittsburgh — where MWRI investigators do their work.

“We’re trained to solve engineering problems, and we need physicians to communicate to us the problems they see so we can get to a potential solution,” he says. “There are so many doctors here [at MWRI and the University of Pittsburgh] invested in figuring out better solutions for treating their patients,” he continues.

Michael Annichine, CEO, Magee-Womens Research Institute, notes, “For the millions of women who suffer from pelvic organ prolapse, the mesh research Drs. Moalli and Abramowitch are working on has the potential to bring relief to women worldwide.  Work like this wouldn’t be possible without the dedication of investigators who understand how to ask the right questions and conduct the painstaking research behind successful treatment.”

To make a donation to this research, or any other area of research at MWRI, contact Kambra McConnel at (412) 641-8922 or email mcconnelk@mwri.magee.edu.