Please cite this paper as: Ozog Y, Konstantinovic M, Werbrouck E, De Ridder D, Mazza E, Deprest J. Persistence of polypropylene mesh anisotropy after implantation: an experimental study. BJOG 2011; DOI: 10.1111/j.1471‐0528.2011.03018.x. Objective To determine whether anisotropy persisted after incorporation into the host, using a standardised rabbit model for abdominal wall reconstruction. Design Investigator‐initiated prospective‐controlled experimental study. Setting Centre for Surgical Technologies, Medical Faculty KU‐Leuven. Sample Fifteen New Zealand White rabbits. Methods In each rabbit, four full thickness primarily repaired abdominal wall defects were covered by a 4 × 5‐cm Prolift+M implant (Johnson & Johnson, Norderstedt, Germany), either with the stiffest (n = 6 rabbits) or most elastic (n = 6) direction parallel to the body axis. Prolift+M contains 32 g/m2 polypropylene, reinforced with polyglecaprone fibres. Harvesting was performed after 30, 60 and 120 days (n = 2 each time‐point). The abdominal wall of three unoperated rabbits was used as negative control. Main outcome measures Contraction, compliance and maximal strain and stress determined by uniaxial tensiometry. Results Anisotropy properties persist at lower, more physiological displacements, but not at higher displacements. The stiffness of a mesh‐augmented repair in the lower strain range remains above that of native tissue. Eventual mesh contraction was limited to 4.3%. Conclusions Anisotropic properties of Prolift+M persist in vivo and shrinkage is minimal. Compliance of mesh‐augmented repair remains less than that of native tissue. The functional consequences of this remain to be studied.
Oral communication abstracts Valsalva. Subjective scores for pelvic floor muscle contraction were given on dynamic 3D and 4D using the standardized ICS terminology for assessment of pelvic muscle contraction (non-functioning, weak, normal or strong). Offline analysis of the datasets was undertaken using the software GE Kretz 4D View. Measurements were taken at the level of minimal hiatal dimensions using the inferior margin of the symphysis pubis as reference point on 2D and 3D datasets. On 2D ultrasound the diameter of the minimal anteroposterior (AP) hiatus, vertical displacement of the bladder neck and levator angle were measured. 3D datasets were used for obtaining AP and left-right diameter as well as area of the hiatus. Results: Complete datasets were available for 349 women. The proportional difference (value A rest-value A contraction/value A rest) between the above parameters was calculated. There were significant correlations (P < 0.001) in all parameters between women with no, weak, normal or strong contractions except for vertical bladder neck displacement. The proportional 2D AP difference between rest and contraction measured in the 2D volume seemed to be the strongest predictor, followed by 3D AP diameter and hiatal area. Conclusions: Proportional differences of the AP measurement between rest and contraction in 2D volumes is the easiest method for quantification of pelvic floor muscle contraction. Surprisingly, vertical bladder neck displacement did not seem to be significant between women with no, weak, normal or strong pelvic floor contractions.
Objectives: Magnetic resonance imaging (MRI) is the gold standard for the investigation of pelvic floor anatomy and function. The objective of this study was to compare biometric measures obtained by 3D ultrasound and MRI. Methods: In this prospective study, translabial 3D ultrasound and multiplanar MRI were used to assess pelvic floor anatomy in 27 nulliparous female volunteers. 3D ultrasound was performed using a GE Kretz Voluson 730/730 Expert system; MR images were obtained using a Siemens MAGNETOM Avanto 1.5-T scanner. All subjects were imaged supine and after voiding for both modalities. Data were acquired at rest, on pelvic floor muscle contraction and on maximal Valsalva. Results: All subjects were asymptomatic for pelvic floor dysfunction. Mean age was 29.3 (21-41) years, mean body mass index was 22.4 (18-29). Measures of hiatal diameters and areas obtained on MRI and 3D ultrasound were distributed normally. Sagittal hiatal diameters correlated at r = 0.533, P = 0.005 at rest, with ranges of 3.8-6.0 cm for MRI and 3.9-5.7 cm for ultrasound. On Valsalva, these figures were r = 0.658, P < 0.001, with ranges of 2.9-8.0 cm on MRI and 3.7-7.3 cm on ultrasound. On pelvic floor muscle contraction, the correlation was r = 0.503, P = 0.01 with ranges of 3.0-5.9 cm on MRI and 3.1-4.7 cm on ultrasound. As regards area measurements, correlations were r = 0.648 at rest and r = 0.542 on Valsalva (P < 0.01). Ranges were 9.1-18.1 on MRI vs. 9.2-17.8 on ultrasound at rest and 6.53-36.5 cm 2 on MRI vs. 10.7-27.9 cm 2 on ultrasound on Valsalva. There was a tendency for larger MRI measurements on Valsalva (P < 0.01 for area and midsagittal diameter). Repeatability measures were good to excellent for both methods. Conclusions: In this study of 3D ultrasound and MRI of the levator hiatus, correlations between methods were moderate but highly significant. MRI seemed to yield higher measurements on Valsalva, suggesting difficulties in identifying the plane of minimal dimensions during maneuvers that led to displacement of this plane. OC260 Ballooning: how to define abnormal distensibility of the levator hiatus
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