The effect of growth factors on vaginal wound healing: a systematic review and meta-analysis.

Surgical outcomes of pelvic organ prolapse surgery are poor, resulting in a 20% recurrence risk. Following the hypothesis that impaired wound healing is the main determinant of recurrent pelvic organ prolapse, growth factors have the potential to promote wound healing and may improve surgical outcomes. Here, we systematically reviewed the effect of growth factors on vaginal wound healing in both in vitro and animal studies. For each independent comparison, the standardized mean difference and 95% CI were calculated using the Hedges' g correction. Of the 3,858 retrieved studies, seven studies were included of which six were included in meta-analysis (three in vitro studies and four in vivo studies). In vitro, basic fibroblast growth factor promotes proliferation, differentiation, and collagen types I and III production. Epidermal growth factor stimulates proliferation and connective tissue growth factor promotes Tenascin-C expression. These effects, however are less pronounced in vivo; only basic fibroblast growth factor slightly promotes collagen production. The review shows that growth factors, particularly basic fibroblast growth factor, are able to promote vaginal wound healing in vitro. The uncertain in vivo findings suggest that pre-clinical models should be improved. The ultimate goal is to develop effective growth factor-supplemented therapies that improve surgical outcomes for pelvic organ prolapse.