Biomaterials in Obstetrics and Gynecology - Biomaterials Science: An Integrated Clinical and Engineering Approach - page 160

The same technique is being used to treat severe bleeding after childbirth.
Despite modern medicine, bleeding remains a leading cause of mortality
during labor. When possible to transfer a bleeding patient to the interven-
tional radiology suite, this treatment may save the patient's life without the
need for a hysterectomy. In conclusion, UFE, with the injection of PVA par-
ticles into the uterine arteries, is a minimally invasive uterine-sparing treat-
ment for fibroids that may also be utilized as a life-saving measure [21-24].
Female Pelvic Reconstructive Surgery
Pelvic floor dysfunction consists of a variety of conditions affecting women in
later reproductive years and after menopause. These include urinary incon-
tinence and pelvic organ prolapse as well as bowel symptoms and sexual
dysfunction. As the population ages, more and more patients present with
these symptoms. Moreover, many more women are now willing to share
their complaints with their gynecologists with an increased demand for
quality of life. Epidemiological studies have shown that up to 50% of women
may experience one or more of these conditions in their lifetime [25]. Many
of these conditions are caused by damage to the vaginal supporting struc-
tures and the fibromuscular layer of the vaginal walls. Vaginal birth, aging,
and conditions that increase abdominal pressure are the main risk factors.
The field of female pelvic medicine and reconstructive surgery utilizes cut-
ting edge technology in the treatment of these conditions. Biomaterials used
in this field include biologic and synthetic grafts and slings, as well as inject-
able bulking agents to treat urinary incontinence. This growing field is prob-
ably the greatest consumer of biomaterials in modern gynecology. Owing
to the limited scope of this chapter, we will discuss only a few examples of
biomaterials used in this field.
Mid-urethral Slings for Stress Urinary Incontinence [25, 26]
Stress urinary incontinence (SUI) is a condition of urine leakage that occurs
with increased intra-abdominal pressure such as coughing, sneezing, and
laughing. It is a common condition that affects millions of women world-
wide at all ages. It prevalence increases with age, and parity is a known risk
factor, especially in the younger age group. The pathogenesis of this condi-
tion is related to the loss of the support provided by the connective tissue
under the urethra, causing urethral hypermobility. In a smaller portion of
the patients, there is an intrinsic defect in the sealing mechanism within the
urethra. Until two decades ago, the surgical treatment of SUI included an
abdominal surgery requiring a lower abdomen incision and recreation of a
hammock-like support under the urethra. Mid-urethral slings have revolu-
tionized the current treatment of SUI. In this procedure, a synthetic polypro-
pylene sling is implanted between the vagina and mid-urethra via a vaginal
incision of 2 cm. This procedure can be performed under local anesthesia or