Three‐dimensional transperineal ultrasound for imaging mesh implants following sacrocolpopexy

Eisenberg, V. H.; Steinberg, M.; Weiner, Zeev; Alcalay, M.; Itskovitz‐Eldor, Joseph; Schiff, Eyal; Löwenstein, Lior

doi:10.1002/uog.13303

Cited by 18 publications

(19 citation statements)

References 17 publications

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“…Indeed, mesh shrinkage (50–70%) has been described to occur after transvaginal insertion of prolapse meshes. 32–37 In the present study, in meshes removed for pain, IL-10, which is a cytokine that, in increased amounts, has been associated with fibrosis, 39–42 positively correlated with the percentage of M2 polarized macrophages (remodeling/fibrotic phenotype), which supports an ongoing remodeling/ fibrotic process that is involved in at least 1 mechanism that leads to pain.…”

Section: Commentsupporting

confidence: 63%

Host response to synthetic mesh in women with mesh complications

Nolfi

Brown

Liang

et al. 2016

American Journal of Obstetrics and Gynecology

106

104

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BACKGROUND Despite good anatomic and functional outcomes, urogynecologic polypropylene meshes that are used to treat pelvic organ prolapse and stress urinary incontinence are associated with significant complications, most commonly mesh exposure and pain. Few studies have been performed that specifically focus on the host response to urogynecologic meshes. The macrophage has long been known to be the key cell type that mediates the foreign body response. Conceptually, macrophages that respond to a foreign body can be dichotomized broadly into M1 proinflammatory and M2 proremodeling subtypes. A prolonged M1 response is thought to result in chronic inflammation and the formation of foreign body giant cells with potential for ongoing tissue damage and destruction. Although a limited M2 predominant response is favorable for tissue integration and ingrowth, excessive M2 activity can lead to accelerated fibrillar matrix deposition and result in fibrosis and encapsulation of the mesh. OBJECTIVE The purpose of this study was to define and compare the macrophage response in patients who undergo mesh excision surgery for the indication of pain vs a mesh exposure. STUDY DESIGN Patients who were scheduled to undergo a surgical excision of mesh for pain or exposure at Magee-Womens Hospital were offered enrollment. Twenty-seven mesh-vagina complexes that were removed for the primary complaint of a mesh exposure (n = 15) vs pain in the absence of an exposure (n = 12) were compared with 30 full-thickness vaginal biopsy specimens from women who underwent benign gynecologic surgery without mesh. Macrophage M1 proinflammatory vs M2 proremodeling phenotypes were examined via immunofluorescent labeling for cell surface markers CD86 (M1) vs CD206 (M2) and M1 vs M2 cytokines via enzyme-linked immunosorbent assay. The amount of matrix metalloproteinase-2 (MMP-2) and matrix metalloproteinase-9 (MMP-9) proteolytic enzymes were quantified by zymography and substrate degradation assays, as an indication of tissue matrix degradation. Statistics were performed with the use of 1-way analysis of variance with appropriate post hoc tests, t-tests, and Fisher’s Exact test. RESULTS Twenty-seven mesh-vaginal tissue complexes were excised from 27 different women with mesh complications: 15 incontinence mid urethral slings and 12 prolapse meshes. On histologic examination, macrophages surrounded each mesh fiber in both groups, with predominance of the M1 subtype. M1 and M2 cytokines/chemokines, MMP-9 (pro- and active), and MMP-2 (active) were increased significantly in mesh-vagina explants, as compared with vagina without mesh. Mesh explants that were removed for exposure had 88.4% higher pro-MMP-9 (P = .035) than those removed for pain. A positive correlation was observed between the profibrotic cytokine interleukin-10 and the percentage of M2 cells (r = 0.697; P = .037) in the pain group. CONCLUSION In women with complications, mesh induces a proinflammatory response that persists years after implantation. The increase in MMP-9 in mesh exp...

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Section: Commentsupporting

confidence: 63%

Host response to synthetic mesh in women with mesh complications

Nolfi

Brown

Liang

et al. 2016

American Journal of Obstetrics and Gynecology

106

104

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“…This finding may also be due to wound contraction as a component of physiological healing during the immediate period following surgery, as was described by Svabik et al 6,7 . Mesh folding seems to be a significant feature of the immediate and later postoperative period 5 . While previous researchers associated vaginal mesh folding with an increased risk of mesh erosion, we did not observe any clinical erosion, in either our previous 5 or our current study.…”

Section: Discussionmentioning

confidence: 99%

“…blinded to the clinical data and findings on pelvic examination. Volume acquisition and manipulation were performed as described previously by Eisenberg et al …”

Section: Methodsmentioning

confidence: 99%

“…blinded to the clinical data and findings on pelvic examination. Volume acquisition and manipulation were performed as described previously by Eisenberg et al 5 . The lowest anterior and posterior mesh positions, relative to the symphysis pubis (SP), were determined in the midsagittal plane with the patient at rest and on maximal Valsalva maneuver.…”

Section: Methodsmentioning

confidence: 99%

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Long‐term follow‐up of sacrocolpopexy mesh implants at two time intervals at least 1 year apart using 4D transperineal ultrasound

Eisenberg

Steinberg

Weiner

et al. 2017

Ultrasound in Obstet & Gyne

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Objective To determine, using four‐dimensional (4D) transperineal ultrasound, whether the appearance, position or dimensions of sacrocolpopexy mesh implants or the degree of tissue support change in the long term. Methods Women who had undergone minimally invasive abdominal sacrocolpopexy for pelvic organ prolapse were invited for follow‐up assessment at two consecutive visits at least 1 year apart. All participants completed a Pelvic Floor Distress Inventory questionnaire (PFDI‐20) and underwent a pelvic examination by one examiner and had 4D ultrasound volumes obtained by a different examiner. Volumes were analyzed offline for mesh position with the woman at rest and on maximal Valsalva maneuver, and for mesh dimensions and characteristics on three‐dimensional orthogonal planes and rendered views, with the operator blinded to the clinical data. Findings were compared between the two examinations. Results Thirty women attended follow‐up assessment at two time points, a median of 22 (range, 12–37) months apart. The median age at the latter visit was 60 (range, 46–72) years, median body mass index was 25.9 (range, 20.8–31.9) kg/m2, median parity was 3 (range, 1–7) and median time from surgery to first and second visit, respectively, was 11.2 (range, 6–26) months and 33.5 (range, 14–56) months. There were no significant differences between the two time points in symptom scores, reported satisfaction from surgery, pelvic examination findings or pelvic organ descent in any compartment according to ultrasound. While mesh dimensions of anterior and posterior arms did not change significantly over time, both arms descended less on Valsalva at the second follow‐up compared with at the first (13.2 ± 6.7 mm vs 21.9 ± 10.0 mm and 9.1 ± 5.3 mm vs 16.1 ± 8.1 mm, respectively, both P < 0.001). There were no mesh erosions, but folding remained a consistent finding, occurring in 80% of women in each assessment. Conclusions Characteristics of tissue support and dimensions of sacrocolpopexy mesh implants remained constant over long‐term follow‐up, with no mesh shrinkage or erosion. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.

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“…As a substitute to MRI‐based imaging, ultra‐sound technique has been described as a powerful method for identifying meshes in gynaecology (through a transvaginal approach after pelvic organ prolapse surgeries) . Unfortunately, the intensity and the quality of the signal attenuation is very dependent on the composition of the meshes and on the anatomical region, which limit, for example, the ability to systematically visualize hernia meshes after implantation in some abdominal areas …”

Section: Post‐implantation Visible Meshmentioning

confidence: 99%

Emerging Trends in Abdominal Wall Reinforcement: Bringing Bio‐Functionality to Meshes

Guillaume

Teuschl

Gruber-Blum

et al. 2015

Adv Healthcare Materials

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Abdominal wall hernia is a recurrent issue world-wide and requires the implantation of over 1 million meshes per year. Because permanent meshes such as polypropylene and polyester are not free of complications after implantation, many mesh modifications and new functionalities have been investigated over the last decade. Indeed, mesh optimization is the focus of intense development and the biomaterials utilized are now envisioned as being bioactive substrates that trigger various physiological processes in order to prevent complications and to promote tissue integration. In this context, it is of paramount interest to review the most relevant bio-functionalities being brought to new meshes and to open new avenues for the innovative development of the next generation of meshes with enhanced properties for functional abdominal wall hernia repair.

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Three‐dimensional transperineal ultrasound for imaging mesh implants following sacrocolpopexy

Abstract: Objective To characterize, using three-dimensional (3D)

Cited by 18 publications

References 17 publications

Host response to synthetic mesh in women with mesh complications

Host response to synthetic mesh in women with mesh complications

Long‐term follow‐up of sacrocolpopexy mesh implants at two time intervals at least 1 year apart using 4D transperineal ultrasound

Emerging Trends in Abdominal Wall Reinforcement: Bringing Bio‐Functionality to Meshes

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