Dynamic evaluation of pelvic floor reconstructive surgery using radiopaque meshes and three-dimensional helical CT

Abstract

Purpose: This prospective study was performed to achieve visualization of the reestablishment of anatomy after reconstructive surgery in the different pelvic compartments with non-absorbable radiopaque meshes, providing valuable anatomic information for surgeons implanting meshes. Materials and Methods: A total of 30 female patients with stress urinary incontinence (SUI), anterior and posterior vaginal wall prolapse, or both underwent surgical repair using radiopaque meshes after written informed consent. Patients with SUI underwent five different surgeries. Patients with anterior vaginal prolapse underwent a procedure using a combined pre-pubic and transobturator mesh, and those with posterior vaginal prolapse underwent posterior slingplasty. Three-dimensional reconstruction using helical CT was performed four weeks postoperatively. Results: In all cases, the mesh was clearly visualized. Transobturator slings were shown at the midurethra, and the anchoring tails perforated the obturator foramen at the safety region. Mini-slings were in the proper place, and computed angiography revealed that the anchoring system was away from the obturator vessels. In patients undergoing procedure for anterior vaginal prolapse, both pre-pubic armpit and obturator slings were clearly seen and the mesh was in the proper position, supporting the bladder base and occluding the distal part of the urogenital hiatus. Transcoccygeal sacropexy revealed indirectly a well-supported "neo rectovaginal fascia" and the anchoring tails at the level of ischial spines. Conclusion: Three-dimensional helical tomography images of the female pelvis using radiopaque meshes have a potential role in improving our understanding of pelvic floor reconstructive surgeries. These radiopaque meshes might be the basis of a new investigative methodology.

Transvaginal Cystocele Repair Using Tension-free Polypropylene Mesh (Tension-free Vaginal Tape)

“…Their size is about 40 cm long and 1 cm wide. By fitting such polypropylene prosthesis or tapes there are created curable pubourethral neoligament, due to the deposition of collagen which forms an artificial neoligament according to Petros' theory [16][17][18]. The tapes activate the fibroblasts that are creating collagen deposition and forming therefore neoligaments.…”

A standardized description of graft-containing meshes and recommended steps before the introduction of medical devices for prolapse surgery

“…We anticipate the increased use of added coatings. Nanoparticles or microparticles, for instance, are used as markers or to deliver drugs locally [11,12]. …”

“…Ex vivo, the active properties of explants, such as contractility, can be determined [42]. Imaging studies can theoretically document conformational changes during integration into the host, using either microultrasound, computerized tomography, or magnetic resonance imaging [11,12]. It seems to us that, at this moment, these novel methods, yet promising, are too investigational to make them basic requirements for experimental evaluation prior to clinically launching a product.…”

The potential of photoacoustic microscopy as a tool to characterize the in vivo degradation of surgical sutures

“…Another possibility would be magnetic-resonance imaging systems, however, their standard spatial resolution and contrast may also not reach the specific needs of this task. For both methods, it is possible to improve the measurable contrast by adding contrast enhancing agents to the matrix of these synthetic polymers (polypropylene, polyester) [3,4], which makes the use of these techniques quite expensive and relatively complex.…”