Safety and Efficacy Report for the Use of Poly-4-Hydroxybutyrate as a Retropubic Mid-Urethral Sling (MUS) for Stress Urinary Incontinence: A Prospective 24 Months Follow-Up of New Poly-4-Hydroxybutyrate TephaFlex SUI Bioresorbable MUS

Krista L. C. van Rest, Arnoud W. Kastelein, Kendall J. Brouard, Lamees Ras, Stephen T. Jeffery, Jan-Paul W. R. Roovers

Research output: Contribution to journalArticleAcademicpeer-review


Study Objective: To investigate the feasibility and safety of the retropubic mid-urethral sling (MUS) procedure with a resorbable mesh implant made of poly-4-hydroxybutyrate (P4HB). Design: A prospective clinical cohort study with 24 months follow-up. Setting: A tertiary academic hospital. Patients: Seventeen women with moderate to severe stress urinary incontinence (SUI). Interventions: A retropubic MUS procedure with P4HB sling. Measurements and Main Results: Seventeen women underwent an uncomplicated MUS procedure with a new sling made of resorbable P4HB. Following safety criteria, there has been no need to stop the study before 24 months’ end point. Three serious adverse events were reported during follow-up: (1) inability to void urine after 1 week postsurgery, (2) a hysterectomy and bilateral oophorectomy performed due to a precancerous endometrial lesion at 16 months after initial MUS procedure and (3) exposed mesh with a part of device sheath left behind. These participants underwent an uncomplicated reintervention with no additional and/or permanent harm. Reinterventions because of failure of cure contained 3 second MUS procedures and one admission of urethral bulking agent. Seventy-six percent and 47 percent of patients were objectively cured of SUI at 12 and 24 months, respectively. Conclusions: Preliminary evidence suggests that a sling made of P4HB can be safely used for MUS procedures and could be an alternative for permanent polypropylene slings in patients that prefer the use of nonpermanent material.
Original languageEnglish
Pages (from-to)131-137
Number of pages7
JournalJournal of Minimally Invasive Gynecology
Issue number2
Publication statusPublished - 1 Feb 2024


  • Absorbable mesh
  • Vaginal implant
  • Vaginal surgery

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