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Robles, Juan Dominguez
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article
3D printing of drug-loaded thermoplastic polyurethane meshes: A potential material for soft tissue reinforcement in vaginal surgery
Abstract
Pelvic Organ Prolapse (POP) or Stress Urinary Incontinence (SUI) are two very common disorders affecting 30-40% of women worldwide. Current strategies to repair or improve these medical conditions are non-surgical options such as physiotherapy, or surgical options such as the use surgical vaginal meshes. The use of the latter has caused some complications such as chronic pain, infection or mesh rupture. Accordingly, a novel approach that does not show such problems is required. Additive manufacturing (AM) technology, also known as 3D-printing was employed to manufacture these new vaginal meshes. For this purpose, thermoplastic polyurethane (TPU) filaments containing levofloxacin (LFX) in various concentrations (e.g., 0, 0.25, 0.5, and 1%) were produced by an extrusion process. The extruded filaments were used in a fused deposition modeling (FDM) 3D printer to print the abovementioned vaginal meshes. The printed meshes were fully characterized trough different test/analysis such as fracture force studies, attenuated total reflection-Fourier transform infrared, thermal analysis, scanning electron microscopy, X-ray microcomputer tomography (μCT) analysis, release studies in phosphate-buffered saline, and microbiology studies. The results showed that LFX was uniformly distributed within the TPU matrix, regardless the concentration tested. The mechanical properties showed that poly(propylene) (PP) is a tougher material with lower elasticity than TPU which seemed to be a more suitable material due to its elasticity. In addition, the printed meshes showed a significant bacteriostatic activity on both Staphylococcus aureus and Escherichia coli cultures minimising the risk of infection after implanting them. Therefore, the incorporation of LFX to the TPU matrix can be used to prepare anti-infective vaginal meshes with enhanced mechanical properties compared with current PP vaginal meshes.