Characterizing the ex vivo textile and structural properties of synthetic prolapse mesh products

Feola, Andrew; Barone, William R.; Moalli, Pamela; Abramowitch, Steven D.

doi:10.1007/s00192-012-1901-1

Cited by 52 publications

(46 citation statements)

References 15 publications

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“…Meshes were implanted via sacrocolpopexy in the Rhesus Macaque. Since UltraPro is highly anisotropic 7-8 , it was implanted with its blue orientation lines perpendicular (low stiffness direction) and parallel (high stiffness direction) to the longitudinal axis of the vagina. The production and degradation of collagen and elastin, collagen subtype III/I ratio as well as the levels of matrix metalloproteinases (MMP) MMPs -1, -2, -8, -9 and -13 were examined.…”

Section: Introductionmentioning

confidence: 99%

Impact of prolapse meshes on the metabolism of vaginal extracellular matrix in rhesus macaque

Liang¹,

Zong²,

Palcsey³

et al. 2015

American Journal of Obstetrics and Gynecology

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Objective The impact of polypropylene mesh implantation on vaginal collagen and elastin metabolism was analyzed using a nonhuman primate model to further delineate the mechanism of mesh induced complications. Methods 49 middle aged parous rhesus macaques underwent surgical implantation of 3 synthetic meshes via sacrocolpopexy. Gynemesh PS (n=12) and two lower weight, higher porosity, lower stiffness meshes - UltraPro (n = 19) and Restorelle (n=8) were implanted, in which UltraPro was implanted with its blue orientation lines perpendicular (low stiffness direction, n=11) and parallel (high stiffness direction, n=8) to the longitudinal axis of vagina. Sham operated animals were used as controls (n=10). Twelve weeks after surgery, the meshtissue complex was excised and analyzed. Results Relative to Sham, Gynemesh PS had a negative impact on the metabolism of both collagen and elastin favoring catabolic reactions while UltraPro only induced an increase in elastin degradation. Restorelle had the least impact. As compared to Sham, the degradation of collagen and elastin in the vagina implanted with Gynemesh PS was increased with a simultaneous increase in active MMP-1, -8, -13 and total MMP-2, -9 (all P<0.05). The degradation of elastin (tropoelastin and mature elastin) was increased in the UltraPro implanted vagina with a concomitant increase of MMP-2, and -9 (all P<0.05). Collagen subtype ratio III/I was increased in both Gynemesh PS and UltraPro perpendicular groups (P<0.05). Conclusion Following implantation with the heavier, less porous and stiffer mesh, Gynemesh PS, the degradation of vaginal collagen and elastin exceeded synthesis, most likely as a result of increased activity of MMPs, resulting in a structurally compromised tissue.

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Section: Introductionmentioning

confidence: 99%

Impact of prolapse meshes on the metabolism of vaginal extracellular matrix in rhesus macaque

Liang¹,

Zong²,

Palcsey³

et al. 2015

American Journal of Obstetrics and Gynecology

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“…As a result, there has been a growing focus on the biomechanics and physical properties of different types of vaginal mesh [9], and efforts to identify patient-centered risk factors for mesh erosion have also increased. Despite these efforts, limited research has been performed on the human host response to synthetic midurethral slings.…”

Section: Introductionmentioning

confidence: 99%

Histopathology of excised midurethral sling mesh

et al. 2014

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“…The newer meshes were found to be significantly lighter than Gynemesh and to have higher porosities (Table 1). Additionally, when subjected to a simple uniaxial load to failure test and the multiaxial ball burst test, current widely used prolapse meshes showed vastly different structural properties [22]. Stiffness is a term that describes the ability of a material to resist deformation under an applied load.…”

Section: Structural Properties and Mechanical Behavior Of Polypropylementioning

confidence: 99%

Exploring the basic science of prolapse meshes

Liang¹,

Knight

Abramowitch

et al. 2016

Current Opinion in Obstetrics &Amp; Gynecology

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Purpose of review Polypropylene mesh has been widely used in the surgical repair of pelvic organ prolapse. However, low but persistent rates of complications related to mesh, most commonly mesh exposure and pain, have hampered its use. Complications are higher following transvaginal implantation prompting the Food and Drug Administration to release two public health notifications warning of complications associated with transvaginal mesh use (PHN 2008 and 2011) and to upclassify transvaginal prolapse meshes from Class II to Class III devices. Although there have been numerous studies to determine the incidence and management of mesh complications as well as impact on quality of life, few studies have focused on mechanisms. Recent findings In this review, we summarize the current understanding of how mesh textile properties and mechanical behavior impact vaginal structure and function, as well as the local immune response. We also discuss how mesh properties change in response to loading. Summary We highlight a few areas of current and future research to emphasize collaborative strategies that incorporate basic science research to improve patient outcomes.

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Characterizing the ex vivo textile and structural properties of synthetic prolapse mesh products

Cited by 52 publications

References 15 publications

Impact of prolapse meshes on the metabolism of vaginal extracellular matrix in rhesus macaque

Impact of prolapse meshes on the metabolism of vaginal extracellular matrix in rhesus macaque

Histopathology of excised midurethral sling mesh

Exploring the basic science of prolapse meshes

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