DEAR MAYO CLINIC: I have read a lot lately about regenerative medicine, and I am wondering if there has been any research conducted on uterine, bladder, vaginal or rectal prolapse.
ANSWER: A number of research studies have been done to investigate pelvic organ prolapse and the possibility of treating it with regenerative medicine. Currently, Mayo Clinic in Arizona — along with Arizona State University — is involved in research regarding the treatment of vaginal prolapse using the principles of regenerative medicine.
Regenerative medicine is an emerging discipline in medicine and surgery, focused on finding ways to boost the body’s ability to heal itself. It examines new therapies and advances new ways to manage diseases that go beyond current medical treatment.
One strategy being explored in this type of medicine is called regeneration. Regeneration reprograms a person’s own cells in a laboratory. Those cells are then delivered back into the body, where they can help treat a medical condition or aid in healing. It is this kind of regenerative medicine that is being investigated for pelvic organ prolapse.
Prolapse happens when pelvic floor muscles and ligaments stretch and weaken. They no longer provide enough support for the pelvic organs, allowing one or more of those organs to slip out of place. Defects in connective tissue, such as collagen and elastin, and problems in cells called fibroblasts may raise the risk for prolapse. In addition, vaginal birth is associated with a significant increase in a woman’s risk for prolapse.
Pelvic organ prolapse affects many women. Urinary incontinence, a problem closely associated with pelvic organ prolapse, also is quite common. About 15 percent of women have incontinence and about 3 percent experience prolapse at some point in their lives. Studies suggest that 19 percent of women have a lifetime risk of needing prolapse surgery. Recurrence of prolapse following surgery ranges from about 15 to 20 percent. The problem often returns because the tissue involved is too weak to keep organs in place.
Given the risk of recurrence, when performing surgery to treat vaginal prolapse some surgeons have placed mesh within the vagina to provide added support and strength. The results of using mesh have been mixed and have created some controversy due to a risk of complications.
Regenerative medicine presents a promising and timely opportunity to address these issues. It offers the potential to lower the risk of prolapse recurrence by using a patient’s own cells to create improved muscle and connective tissue, as well as improve the substance between the cells, called matrix.
Regenerative medicine researchers have had success in using adult stem cells to create special muscle cells that can be injected directly into the urethral wall to reduce urinary incontinence. Some of these studies have already been done in human subjects.
Mayo Clinic in Arizona and Arizona State University are collaborating on a regenerative project for vaginal prolapse that involves creating a tissue-engineered vaginal implant. The ultimate goal will be to use this technique to decrease the risk of vaginal prolapse from happening again after surgery.
In the not-so-distant future, it may be possible to take a vaginal biopsy from a woman who has had prolapse and transform cells grown in the laboratory into cells that do not show the effects of aging. The new cells would then be used to create stronger tissue to repair the patient’s prolapse.
The progress to date on this and other similar research projects points to the promising future that regenerative medicine may hold for treating disease and helping the body heal itself. — Jeffrey Cornella, M.D., Gynecologic Surgery, Mayo Clinic, Scottsdale, Ariz.