Vaginal degeneration following implantation of synthetic mesh with increased stiffness. Issue 2 (14th December 2012)

• Record Type: Journal Article
• Authors: Liang, R; Abramowitch, S; Knight, K; Palcsey, S; Nolfi, A; Feola, A; Stein, S; Moalli, PA
• Is Part Of: BJOG. Volume 120:Issue 2(2013:Feb.)
• Page Start: 233
• Page End: 243
• Publication Date: 2012-12-14
• Subjects: Obstetrics -- Periodicals; Gynecology -- Periodicals; 618
• DOI: 10.1111/1471-0528.12085
• Languages: English
• ISSNs: 1470-0328

Abstract

<abstract abstract-type="main" id="bjo12085-abs-0001"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="bjo12085-sec-0001" sec-type="section"> <title>Objective</title> <p>To compare the impact of the prototype prolapse mesh Gynemesh PS with that of two new‐generation lower stiffness meshes, UltraPro and SmartMesh, on vaginal morphology and structural composition.</p> </sec> <sec id="bjo12085-sec-0002" sec-type="section"> <title>Design</title> <p>A mechanistic study employing a nonhuman primate model.</p> </sec> <sec id="bjo12085-sec-0003" sec-type="section"> <title>Setting</title> <p>Magee‐Womens Research Institute at the University of Pittsburgh.</p> </sec> <sec id="bjo12085-sec-0004" sec-type="section"> <title>Population</title> <p>Parous rhesus macaques, with similar age, weight, parity and Pelvic Organ Prolapse‐Questionnaire scores.</p> </sec> <sec id="bjo12085-sec-0005" sec-type="section"> <title>Methods</title> <p>Following Institutional Animal Care Use Committee approval, 50 rhesus macaques were implanted with Gynemesh PS (<italic>n</italic> = 12), UltraPro with its blue line perpendicular to the longitudinal axis of vagina (<italic>n</italic> = 10), UltraPro with its blue line parallel to the longitudinal axis of vagina (<italic>n</italic> = 8) or SmartMesh (<italic>n</italic> = 8) via sacrocolpopexy following hysterectomy. Sham‐operated animals (<italic>n</italic> = 12) served as controls.</p> </sec> <sec id="bjo12085-sec-0006" sec-type="section"> <title>Main outcome measures</title> <p>The mesh–vagina complex was removed after 12 weeks and analysed for histomorphology, <italic>in situ</italic> cell apoptosis, total collagen, elastin, glycosaminoglycan content and total collagenase activity. Appropriate statistics and correlation analyses were performed accordingly.</p> </sec> <sec id="bjo12085-sec-0007" sec-type="section"> <title>Results</title> <p>Relative to sham and the two lower stiffness meshes, Gynemesh PS had the greatest negative impact on vaginal histomorphology and composition. Compared with sham, implantation with Gynemesh PS caused substantial thinning of the smooth muscle layer (1557 ± 499 μm versus 866 ± 210 μm, <italic>P</italic> = 0.02), increased apoptosis particularly in the area of the mesh fibres (<italic>P</italic> = 0.01), decreased collagen and elastin content (20%, <italic>P</italic> = 0.03 and 43%, <italic>P</italic> = 0.02, respectively) and increased total collagenase activity (135%, <italic>P</italic> = 0.01). Glycosaminoglycan, a marker of tissue injury, was highest with Gynemesh PS compared with sham and other meshes (<italic>P</italic> = 0.01).</p> </sec> <sec id="bjo12085-sec-0008" sec-type="section"> <title>Conclusion</title> <p>Mesh implantation with the stiffer mesh Gynemesh PS induced a maladaptive remodelling response consistent with vaginal degeneration.</p> </sec> </abstract>