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Vaginal degeneration following implantation of synthetic mesh with increased stiffness
Author(s) -
Liang R,
Abramowitch S,
Knight K,
Palcsey S,
Nolfi A,
Feola A,
Stein S,
Moalli PA
Publication year - 2013
Publication title -
bjog: an international journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.157
H-Index - 164
eISSN - 1471-0528
pISSN - 1470-0328
DOI - 10.1111/1471-0528.12085
Subject(s) - elastin , vagina , collagenase , population , medicine , anatomy , andrology , urology , gynecology , endocrinology , pathology , biology , biochemistry , enzyme , environmental health
Objective To compare the impact of the prototype prolapse mesh G ynemesh PS with that of two new‐generation lower stiffness meshes, U ltra P ro and S mart M esh, on vaginal morphology and structural composition. Design A mechanistic study employing a nonhuman primate model. Setting Magee‐Womens Research Institute at the University of P ittsburgh. Population Parous rhesus macaques, with similar age, weight, parity and Pelvic Organ Prolapse‐Questionnaire scores. Methods Following Institutional Animal Care Use Committee approval, 50 rhesus macaques were implanted with G ynemesh PS ( n = 12), UltraPro with its blue line perpendicular to the longitudinal axis of vagina ( n = 10), UltraPro with its blue line parallel to the longitudinal axis of vagina ( n = 8) or SmartMesh ( n = 8) via sacrocolpopexy following hysterectomy. Sham‐operated animals ( n = 12) served as controls. Main outcome measures The mesh–vagina complex was removed after 12 weeks and analysed for histomorphology, in situ cell apoptosis, total collagen, elastin, glycosaminoglycan content and total collagenase activity. Appropriate statistics and correlation analyses were performed accordingly. Results Relative to sham and the two lower stiffness meshes, G ynemesh PS had the greatest negative impact on vaginal histomorphology and composition. Compared with sham, implantation with G ynemesh PS caused substantial thinning of the smooth muscle layer (1557 ± 499 μm versus 866 ± 210 μm, P = 0.02), increased apoptosis particularly in the area of the mesh fibres ( P = 0.01), decreased collagen and elastin content (20%, P = 0.03 and 43%, P = 0.02, respectively) and increased total collagenase activity (135%, P = 0.01). Glycosaminoglycan, a marker of tissue injury, was highest with G ynemesh PS compared with sham and other meshes ( P = 0.01). Conclusion Mesh implantation with the stiffer mesh G ynemesh PS induced a maladaptive remodelling response consistent with vaginal degeneration.