Generic Portal

My research focuses on 3 areas:

1. Clinical evaluation of innovative surgical procedures (clinical)

2. Effects of vaginal surgery on pelvic floor function (clinical / translational)

3. Developing a new generation of meshes for prolapse surgery (translational)

1. Clinical evaluation of innovative surgical procedures (clinical)

Uro-gynaecology is dominated by the rapid introduction of innovative surgical procedures. Although these procedures may have a benefit for the patient, it is important that prior to market introduction there is sufficient clinical evaluation to assess whether the new procedure is safe and efficacious. In addition the optimal positioning in existing treatment protocols has to be assessed. After that the organization of care needs attention involving issues like: centralisation of expertise, learning curve, patient preference, needed volume for favorable outcome, and so on. Together with the urogynaecology consortium, clinical epidemiologists, cost-effectiveness experts, implementation experts and clinical psychologists with special interest for patient preference and doctor's attitudes towards innovation, our study group plays an important role in the assessment of innovative surgical procedures.

2. Effects of vaginal surgery on pelvic floor function (clinical / translational)

In pelvic surgery the intention is to improve quality of life. The function of the pelvic floor (involving micturition, defecation and sexual functioning), may however worsen after pelvic surgery, and as a reults the intention to improve quality of life, is sometimes not realized due to the development of new problems. Negative effects on pelvic floor function may be related to damage of pelvic vascularisation and innervation occurring during surgery. An improved understanding of the effects of surgery on the pathophysiology of the vagina and its surrounding organs, imrpoves the understanding between anatomy and function of the pelvic floor and between surgery and functional outcome. We study the effects of vaginal surgery on pelvic floor function to improve counseling and to optimize the technique in such a way that the goal of curgery is achieved: optimal improvement of symptoms with minimal trauma and optimal pelvic floor function after surgery.

In this research we collaborate with the division of sexology (Prof Dr Ellen Laan), department of physiology (Prof Dr Can Ince), department of pathology, department of radiology (Prof Dr J Stoker), clinical psychology (Prod Dr M Sprangers), the dutch urogynaecology department and many others.  

3. Developing a new generation of meshes for prolapse surgery

Pelvic organ prolapse (POP) is a major clinical issue. Most patients are post-menopausal women, but the number of younger patients in increasing. Vaginal implants are used in reconstructive surgery to induce a host reponse that results in the formation of new collagen and elastin. Without foreign body, reconstructive surgery depends on the existing support tissues, and failure rates are in the range of 25-30%. Existing synthetic materials have significant complication rates, which results in restrictive use of these materials in daily clinical practice.

The clinical need for a new generation of pelvic meshes is obvious for all players in the field, patients, surgeons, and companies. However, this requires a better understanding of the function of such an implant and about how the body reacts to a foreign material. The most important complicating factors are: 1. the mechanical discrepancy between the implant and the pelvic tissues; and 2. the fact that the pelvic region is far from sterile. The latter means that the new implant should also consider the presence of bacteria that may form a biofilm and inhibit smooth incorporation of the implant into the host tissue. The first implies that the mesh should not only have sufficient strength, but also specific stiffness and hardness to accommodate the cells that should regenerate the pelvic floor. Finally, especially in younger patients it would be desirable to have only a temporary support, allowing the tissue to regenerate and restore its mechanical function. This may not be possible or necessary in older patients where the regenerative capacity is limited.

The Centre of Translational Regenerative Medicine (CTRM), a newly formed network organisation at the University Medical Centers Amsterdam (VUmc and AMC), addresses these challenges with an interdisciplinary research team. The group around Uro-Gynaecologist and Principle Investigator Jan Paul Roovers consists of Prof. Theo Smit (biomechanics and mechanobiology); Dr. Sebastiaan Zaat (microbiology); Dr. Marco Helder (cell biology); Mrs. Mahshid Vashaghian MSc (electrospinning), Dr Zeliha Güler (biomaterial specialist) and Mrs Chantal Diedrich (uro-gynaecology)..

Together with external partners (electrospinning technology, delayed resorbable biomaterials, antimicrobiol coating technology, collagen matabolism modifucation)  CTRM designs concepts of meshes that specifically address the issues mentioned above. Lab expertise includes advanced electrospinning technologies; biomechanical and mechanobiological testing; microbiological assays; (stem) cell biology, in particular adipose tissue derived stem cells; and surgical expertise on both, animal models and human patients. CTRM includes many other expertises that may be of interest, among which the synthesis of biological (degradable) polymers and GMP facilities.

CTRM, represented in this matter by principle investigator Prof Jan-Paul Roovers and Prof Theo Smit, acknowledges the urgent medical need of pelvic floor reconstructions and wish to explore the possibilities of developing a new generation of pelvic meshes.