The outcome of transobturator anterior vaginal wall prolapse repair using porcine dermis graft: intermediate term follow-up

Abstract

Introduction and Hypothesis:We evaluated the anatomical success and complications of Perigee® with porcine dermis Graft in the repair of anterior vaginal wall prolapse (AVWP) Materials and Methods: After Institutional Review Board (IRB) approval, the charts of all patients who underwent AVWP repair using the Perigee/InteXen® kit from July 2005 to July 2009 were reviewed. Patients who had less than 6-month follow-up were excluded. Preoperative data including patient age, previous AVWP repairs, hysterectomy status, preoperative dyspareunia and pertinent physical findings were collected and recorded. Postoperative success was defined as anatomical stage 0 or I using the Pelvic Organ Prolapse Quantification (POP-Q) scoring system. Graft related complications were also recorded. Results: Out of 89 patients, 69 completed at least 6-month follow-up. Median follow-up was 13 (6-48) months. Seventeen patients (25%) had previous AVWP repair and 32 (46%) had previous hysterectomy. Preoperatively, AVWP stage II was found in 9 (13%), stage III in 27 (39%) and stage IV in 33 (48%) patients. Anatomic success was found in 48 (69%) patients, with 23 (33%) having stage 0 and 25 (36%) stage I AVWP. Intraoperative complications included incidental cystotomy in one patient and bladder perforation in one. Postoperative complications included vaginal exposure and dyspareunia in one case, wound dehiscence in one and tenderness over the graft arm with dyspareunia in one. Conclusions: The use of porcine dermis in AVWP repair is safe with minimal graft related complications; however, anatomical success is lower than that reported with the use of synthetic grafts.

Role of Fibroblasts and Myofibroblasts on the Pathogenesis and Treatment of Pelvic Organ Prolapse

“…In addition, their performances are worse as compared to synthetic implants. For instance, degradable xenografts such as InteXEN ® [ 23 ] and Surgisis ® (Armitage, Seman et al, 2012) undergo rapid in vivo degradation, and the load-bearing capacity of the remodeled tissue is insufficient [ 24 , 25 ]. Synthetic implants are advantageous to eliminate the risk of transmission of infectious diseases and they can be produced with specific textural, mechanical, and structural features to optimize their performance.…”

Bioengineering Strategies to Treat Female Infertility

“…Vaginal agenesis, the congenital underdevelopment of the vagina, occurs in 1 out of 5000 females. [55][56][57] Various biomaterials have been used to fabricate vaginal grafts, including dermal matrix, 55,56,[58][59][60][61] SIS, 53,[62][63][64][65][66][67] and human amniotic membrane. 68 Recently, there have been several investigators that explored different biomaterials and cell sources to create tissue engineered constructs for vaginal agenesis therapies (Table 3).…”