{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,15]],"date-time":"2025-08-15T01:04:05Z","timestamp":1755219845629,"version":"3.43.0"},"reference-count":50,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,8,7]],"date-time":"2025-08-07T00:00:00Z","timestamp":1754524800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Bioeng. Biotechnol."],"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p>Implantation of mid-urethral slings (MUSs) is a safe and effective approach for the surgical repair of stress urinary incontinence. However, concerns regarding the deformability of the prototype MUS, mechanical cut Gynecare TVT prompted manufacturers to use techniques like laser cutting, heat-sealing, and the inclusion of an interwoven stabilizing suture to decrease deformation with loading. We hypothesized that a laser cut or heat-sealed MUS would be stiffer but deform less, and experience less permanent elongation as compared to a mechanical cut MUS. Additionally, the inclusion of a stabilizing suture would minimize the loss of porosity.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Uniaxial tensile testing to failure and cyclic loading was performed to analyze the structural properties and permanent elongation, respectively, of commercially available MUSs Gynecare TVT (mechanical cut), Gynecare TVT Exact (laser cut), ArcTV (laser cut, with and without the stabilizing suture), and Desara Blue (heat-sealed). A custom Mathematica code was used to quantify the porosity of the MUSs following sequential uniaxial loading from 0\u00a0N to 10\u00a0N.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Desara Blue was significantly stiffer (p-values &amp;lt; 0.05), elongated less at failure (p = 0.002), and experienced less permanent elongation in response to cyclic loading (p-values = 0.001) relative to Gynecare TVT. Similarly, permanent elongation was significantly less (p-values = 0.004) and the stiffness was higher (p = 0.004) for Gynecare TVT Exact as compared to Gynecare TVT. Very little differences in stiffness and no differences in relative elongation at failure nor permanent elongation were observed between ArcTV (without the interwoven suture) and Gynecare TVT (p-values &amp;gt; 0.05). The porosity of all MUSs significantly decreased with loading (p-values &amp;lt; 0.001); except for ArcTV with the stabilizing suture which showed the least amount of deformation (i.e., percent change in porosity decreasing by only 14%, p &amp;lt; 0.001, at 10\u00a0N).<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>Overall, heat-sealing decreased deformability at the cost of markedly increasing device stiffness to a point which likely outweighs benefits, and risks increased complications. Laser cutting had different effects on the behavior of TVT Exact and ArcTV suggesting manufacturer technical differences, but overall reduced deformation without a substantial impact on stiffness. An interwoven stabilizing suture minimized the loss of porosity which translates clinically to less deformation and mechanistically to reduced mesh complications.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fbioe.2025.1543808","type":"journal-article","created":{"date-parts":[[2025,8,7]],"date-time":"2025-08-07T11:38:32Z","timestamp":1754566712000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Characterizing the structural properties and porosity of mid-urethral slings with varied manufacturing techniques"],"prefix":"10.3389","volume":"13","author":[{"given":"Katrina","family":"Knight","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Leslie","family":"Meyn","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pamela","family":"Moalli","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2025,8,7]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"110","DOI":"10.1111\/j.1464-410x.2004.04910.x","article-title":"Complications of tension-free vaginal tape surgery: a multi-institutional review","volume":"94","author":"Abouassaly","year":"2004","journal-title":"BJU Int."},{"key":"B2","doi-asserted-by":"publisher","first-page":"166.e1","DOI":"10.1016\/j.ajog.2021.03.016","article-title":"Prevalence and trends in urinary incontinence among women in the United States, 2005-2018","volume":"225","author":"Abufaraj","year":"2021","journal-title":"Am. J. Obstet. Gynecol."},{"key":"B3","doi-asserted-by":"publisher","first-page":"2440","DOI":"10.3390\/healthcare12232440","article-title":"The prevalence and risk factors of stress urinary incontinence among women in Saudi Arabia: a systematic review and meta-analysis","volume":"12","author":"Alhamoud","year":"2024","journal-title":"Healthcare"},{"key":"B4","doi-asserted-by":"publisher","first-page":"1180","DOI":"10.1111\/jog.13035","article-title":"Long-term patient satisfaction after retropubic and transobturator mid-urethral slings for female stress urinary incontinence","volume":"42","author":"Al-Zahrani","year":"2016","journal-title":"J. Obstet. Gynaecol. Res."},{"key":"B5","doi-asserted-by":"publisher","first-page":"203","DOI":"10.1016\/j.actbio.2019.07.031","article-title":"Mesh induced fibrosis: the protective role of T regulatory cells","volume":"96","author":"Artsen","year":"2019","journal-title":"Acta biomater."},{"key":"B6","doi-asserted-by":"publisher","first-page":"326.e1","DOI":"10.1016\/j.ajog.2016.03.023","article-title":"Textile properties of synthetic prolapse mesh in response to uniaxial loading","volume":"215","author":"Barone","year":"2016","journal-title":"Am. J. Obstetrics Gynecol."},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1007\/s00192-025-06146-6","article-title":"Female urinary incontinence in Africa: prevalence estimates from a systematic review and meta-analysis","author":"Bertuit","year":"2025","journal-title":"Int. Urogynecology J."},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.cd008709.pub4","article-title":"Single\u2010incision sling operations for urinary incontinence in women","volume":"2023","author":"Carter","year":"2023","journal-title":"Cochrane Database Syst. Rev."},{"key":"B9","doi-asserted-by":"publisher","first-page":"18","DOI":"10.1016\/j.bsbt.2016.02.003","article-title":"Effect of particle size on biological response by human monocyte-derived macrophages","volume":"2","author":"Chikaura","year":"2016","journal-title":"Biosurface Biotribology"},{"key":"B10","doi-asserted-by":"publisher","first-page":"78","DOI":"10.1038\/nrurol.2012.243","article-title":"Surgical management of female SUI: is there a gold standard?","volume":"10","author":"Cox","year":"2013","journal-title":"Nat. Rev. Urol."},{"key":"B11","doi-asserted-by":"publisher","first-page":"188","DOI":"10.1097\/spv.0000000000001094","article-title":"Long-term outcomes after midurethral mesh sling surgery for stress urinary incontinence","volume":"28","author":"Dejene","year":"2022","journal-title":"Female pelvic Med. Reconstr. Surg."},{"key":"B12","doi-asserted-by":"publisher","first-page":"21","DOI":"10.1007\/bf00451858","article-title":"Cough transmission pressure to the bladder and urethra among continent and incontinent elderly women","volume":"1","author":"Diokno","year":"1991","journal-title":"Geriatric Nephrol. Urology"},{"key":"B13","doi-asserted-by":"publisher","first-page":"1036","DOI":"10.21037\/tau-2024-695","article-title":"Three-dimensional measurement and analysis of the compressor urethrae and urethra in postpartum women","volume":"14","author":"Feng","year":"2025","journal-title":"Transl. Androl. Urol."},{"key":"B14","doi-asserted-by":"publisher","first-page":"224","DOI":"10.1111\/1471-0528.12077","article-title":"Deterioration in biomechanical properties of the vagina following implantation of a high-stiffness prolapse mesh","volume":"120","author":"Feola","year":"2013","journal-title":"BJOG An Int. J. Obstetrics Gynaecol."},{"key":"B15","doi-asserted-by":"publisher","first-page":"CD006375","DOI":"10.1002\/14651858.cd006375.pub4","article-title":"Mid\u2010urethral sling operations for stress urinary incontinence in women","volume":"2017","author":"Ford","year":"2017","journal-title":"Cochrane Database Syst. Rev."},{"key":"B16","doi-asserted-by":"publisher","first-page":"2107","DOI":"10.1007\/s00192-023-05510-8","article-title":"A 10- to 20-year follow-up after tension-free vaginal tape for stress urinary incontinence","volume":"34","author":"Goessens","year":"2023","journal-title":"Int. Urogynecol J."},{"key":"B17","doi-asserted-by":"publisher","first-page":"59","DOI":"10.1007\/s100290100001","article-title":"The influence of differing pore sizes on the biocompatibility of two polypropylene meshes in the repair of abdominal defects: experimental study in dogs","volume":"5","author":"Greca","year":"2001","journal-title":"Hernia"},{"key":"B18","doi-asserted-by":"publisher","first-page":"45","DOI":"10.1007\/s10029-007-0276-6","article-title":"The influence of porosity on the integration histology of two polypropylene meshes for the treatment of abdominal wall defects in dogs","volume":"12","author":"Greca","year":"2008","journal-title":"Hernia"},{"key":"B19","doi-asserted-by":"publisher","first-page":"1659","DOI":"10.1001\/jama.2018.14997","article-title":"Long-term rate of mesh sling removal following midurethral mesh sling insertion among women with stress urinary incontinence","volume":"320","author":"Gurol-Urganci","year":"2018","journal-title":"Jama"},{"key":"B20","doi-asserted-by":"publisher","first-page":"535","DOI":"10.1097\/00006250-200004000-00011","article-title":"Differential effects of cough, valsalva, and continence status on vesical neck movement","volume":"95","author":"Howard","year":"2000","journal-title":"Obstet. Gynecol."},{"key":"B21","doi-asserted-by":"publisher","first-page":"324","DOI":"10.1111\/j.1464-410x.2003.04609.x","article-title":"The prevalence of urinary incontinence in women in four European countries","volume":"93","author":"Hunskaar","year":"2004","journal-title":"BJU Int."},{"key":"B22","doi-asserted-by":"publisher","first-page":"1076","DOI":"10.1111\/1471-0528.13514","article-title":"The impact of prolapse mesh on vaginal smooth muscle structure and function","volume":"123","author":"Jallah","year":"2016","journal-title":"BJOG Int. J. Obstetrics Gynaecol."},{"key":"B23","doi-asserted-by":"publisher","first-page":"845","DOI":"10.1097\/AOG.0b013e31824b2e3e","article-title":"Trends in the surgical management of stress urinary incontinence","volume":"119","author":"Jonsson","year":"2012","journal-title":"Obstet. Gynecol."},{"key":"B24","doi-asserted-by":"publisher","first-page":"1613","DOI":"10.1007\/s00192-012-1770-7","article-title":"Maximum urethral closure pressure in women: normative data and evaluation as a diagnostic test","volume":"23","author":"Kapoor","year":"2012","journal-title":"Int. Urogynecol J."},{"key":"B25","doi-asserted-by":"publisher","first-page":"208","DOI":"10.1006\/jsre.2002.6358","article-title":"Impact of polymer pore size on the interface scar formation in a rat model","volume":"103","author":"Klinge","year":"2002","journal-title":"J. Surg. Res."},{"key":"B26","doi-asserted-by":"publisher","first-page":"323","DOI":"10.1016\/j.actbio.2022.05.051","article-title":"Mesh deformation: a mechanism underlying polypropylene prolapse mesh complications in vivo","volume":"148","author":"Knight","year":"2022","journal-title":"Acta biomater."},{"key":"B27","doi-asserted-by":"publisher","first-page":"2922","DOI":"10.1038\/s41598-017-03086-0","article-title":"The shape and size of hydroxyapatite particles dictate inflammatory responses following implantation","volume":"7","author":"Lebre","year":"2017","journal-title":"Sci. Rep."},{"key":"B28","doi-asserted-by":"publisher","first-page":"48","DOI":"10.1016\/j.euros.2024.08.007","article-title":"Prevalence and spatial distribution characteristics of female stress urinary incontinence in mainland China","volume":"68","author":"Li","year":"2024","journal-title":"Eur. Urology Open Sci."},{"key":"B29","doi-asserted-by":"publisher","first-page":"233","DOI":"10.1111\/1471-0528.12085","article-title":"Vaginal degeneration following implantation of synthetic mesh with increased stiffness","volume":"120","author":"Liang","year":"2013","journal-title":"BJOG An Int. J. Obstetrics Gynaecol."},{"key":"B30","doi-asserted-by":"publisher","first-page":"5728","DOI":"10.3390\/jcm13195728","article-title":"Efficacy of the sub-urethral transobturator KIM system(\u00ae) for female urinary incontinence: long term results","volume":"13","author":"Lorenzo-G\u00f3mez","year":"2024","journal-title":"J. Clin. Med."},{"key":"B31","first-page":"S3","article-title":"The definition, prevalence, and risk factors for stress urinary incontinence","author":"Luber","year":"2004","journal-title":"Rev. Urol."},{"key":"B32","doi-asserted-by":"publisher","first-page":"1087","DOI":"10.1007\/s00192-016-2949-0","article-title":"Quantitative analyses of variability in normal vaginal shape and dimension on MR images","volume":"27","author":"Luo","year":"2016","journal-title":"Int. Urogynecol J."},{"key":"B33","doi-asserted-by":"publisher","first-page":"e21100","DOI":"10.1097\/md.0000000000021100","article-title":"Feasibility of measuring urethral pressure during female midurethral slings: case report","volume":"99","author":"Meng","year":"2020","journal-title":"Med. Baltim."},{"key":"B34","doi-asserted-by":"publisher","first-page":"655","DOI":"10.1007\/s00192-007-0499-1","article-title":"Tensile properties of five commonly used mid-urethral slings relative to the TVT","volume":"19","author":"Moalli","year":"2008","journal-title":"Int. Urogynecology J. Pelvic Floor Dysfunct."},{"key":"B35","doi-asserted-by":"publisher","first-page":"1265","DOI":"10.1007\/s00192-013-2090-2","article-title":"Seventeen years' follow-up of the tension-free vaginal tape procedure for female stress urinary incontinence","volume":"24","author":"Nilsson","year":"2013","journal-title":"Int. Urogynecol J."},{"key":"B36","doi-asserted-by":"publisher","first-page":"284","DOI":"10.1002\/nau.20980","article-title":"Minimally invasive synthetic suburethral sling operations for stress urinary incontinence in women: a short version cochrane review","volume":"30","author":"Ogah","year":"2011","journal-title":"Neurourol. Urodyn."},{"key":"B37","doi-asserted-by":"publisher","first-page":"423","DOI":"10.1016\/j.jss.2011.09.031","article-title":"Comparative analysis of histopathologic effects of synthetic meshes based on material, weight, and pore size in mice","volume":"176","author":"Orenstein","year":"2012","journal-title":"J. Surg. Res."},{"key":"B38","doi-asserted-by":"publisher","first-page":"2034","DOI":"10.1111\/1471-0528.16778","article-title":"Symptomatic improvement after mesh removal: a prospective longitudinal study of women with urogynaecological mesh complications","volume":"128","author":"Pace","year":"2021","journal-title":"BJOG Int. J. obstetrics Gynaecol."},{"key":"B39","doi-asserted-by":"publisher","first-page":"557","DOI":"10.1302\/0301-620x.91b4.21580","article-title":"The influence of the mechanical environment on remodelling of the patellar tendon","volume":"91","author":"Rumian","year":"2009","journal-title":"J. bone Jt. Surg. Br."},{"key":"B40","doi-asserted-by":"publisher","first-page":"300060520925651","DOI":"10.1177\/0300060520925651","article-title":"Prevalence of stress urinary incontinence and its impact on quality of life among women in Jordan: a correlational study","volume":"48","author":"Sawaqed","year":"2020","journal-title":"J. Int. Med. Res."},{"key":"B41","doi-asserted-by":"publisher","first-page":"104281","DOI":"10.1016\/j.jmbbm.2020.104281","article-title":"Erosion of soft tissue by polypropylene mesh products","volume":"115","author":"Schmidt","year":"2021","journal-title":"J. Mech. Behav. Biomed. Mater."},{"key":"B42","doi-asserted-by":"publisher","first-page":"330.e1","DOI":"10.1016\/j.ajog.2019.05.008","article-title":"Impact of polypropylene prolapse mesh on vaginal smooth muscle in rhesus macaque","volume":"221","author":"Shaffer","year":"2019","journal-title":"Am. J. Obstetrics Gynecol."},{"key":"B43","doi-asserted-by":"publisher","first-page":"78.e1","DOI":"10.1016\/j.ajog.2020.07.005","article-title":"Comparison of 2 single incision slings on the vagina in an ovine model","volume":"224","author":"Shapiro","year":"2020","journal-title":"Am. J. Obstetrics Gynecol."},{"key":"B44","doi-asserted-by":"publisher","first-page":"148","DOI":"10.1016\/j.eururo.2016.01.037","article-title":"Long-term impact of mode of delivery on stress urinary incontinence and urgency urinary incontinence: a systematic review and meta-analysis","volume":"70","author":"T\u00e4htinen","year":"2016","journal-title":"Eur. Urol."},{"key":"B45","doi-asserted-by":"publisher","first-page":"187.e1","DOI":"10.1016\/j.ajog.2018.11.121","article-title":"Characterization of the T-cell response to polypropylene mesh in women with complications","volume":"220","author":"Tennyson","year":"2019","journal-title":"Am. J. Obstetrics Gynecol."},{"key":"B46","doi-asserted-by":"publisher","first-page":"378.e1","DOI":"10.1016\/j.ajog.2009.11.021","article-title":"The incidence of urinary incontinence across Asian, Black, and white women in the United States","volume":"202","author":"Townsend","year":"2010","journal-title":"Am. J. Obstet. Gynecol."},{"key":"B47","doi-asserted-by":"publisher","first-page":"727","DOI":"10.1007\/s00192-019-04223-1","article-title":"Long-term re-procedure rate after mid-urethral slings for stress urinary incontinence","volume":"31","author":"Tulokas","year":"2020","journal-title":"Int. Urogynecol J."},{"key":"B48","doi-asserted-by":"publisher","first-page":"81","DOI":"10.1007\/bf01902378","article-title":"An ambulatory surgical procedure under local anesthesia for treatment of female urinary incontinence","volume":"7","author":"Ulmsten","year":"1996","journal-title":"Int. Urogynecology J. Pelvic Floor Dysfunct."},{"key":"B49","doi-asserted-by":"publisher","first-page":"2428","DOI":"10.1056\/nejmcp1914037","article-title":"Stress incontinence in women","volume":"384","author":"Wu","year":"2021","journal-title":"N. Engl. J. Med."},{"key":"B50","doi-asserted-by":"publisher","first-page":"23","DOI":"10.1115\/1.2895466","article-title":"Effects of stress shielding on the mechanical properties of rabbit patellar tendon","volume":"115","author":"Yamamoto","year":"1993","journal-title":"J. Biomech. Eng."}],"container-title":["Frontiers in Bioengineering and Biotechnology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fbioe.2025.1543808\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,7]],"date-time":"2025-08-07T11:38:33Z","timestamp":1754566713000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fbioe.2025.1543808\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,7]]},"references-count":50,"alternative-id":["10.3389\/fbioe.2025.1543808"],"URL":"https:\/\/doi.org\/10.3389\/fbioe.2025.1543808","relation":{},"ISSN":["2296-4185"],"issn-type":[{"value":"2296-4185","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,7]]},"article-number":"1543808"}}