R Liang1, S Abramowitch2, K Knight2, S Palcsey1, A Nolfi1, A Feola2, S Stein1, P A Moalli1. 1. Magee-Womens Research Institute, Department of Obstetrics and Gynecology, School of Medicine, Pittsburgh, PA, USA. 2. Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA, USA.
Abstract
OBJECTIVE: To compare the impact of the prototype prolapse mesh Gynemesh PS with that of two new-generation lower stiffness meshes, UltraPro and SmartMesh, on vaginal morphology and structural composition. DESIGN: A mechanistic study employing a nonhuman primate model. SETTING: Magee-Womens Research Institute at the University of Pittsburgh. POPULATION: Parous rhesus macaques, with similar age, weight, parity and Pelvic Organ Prolapse-Questionnaire scores. METHODS: Following Institutional Animal Care Use Committee approval, 50 rhesus macaques were implanted with Gynemesh PS (n = 12), UltraPro with its blue line perpendicular to the longitudinal axis of vagina (n = 10), UltraPro with its blue line parallel to the longitudinal axis of vagina (n = 8) or SmartMesh (n = 8) via sacrocolpopexy following hysterectomy. Sham-operated animals (n = 12) served as controls. MAIN OUTCOME MEASURES: The mesh-vagina complex was removed after 12 weeks and analysed for histomorphology, in situ cell apoptosis, total collagen, elastin, glycosaminoglycan content and total collagenase activity. Appropriate statistics and correlation analyses were performed accordingly. RESULTS: Relative to sham and the two lower stiffness meshes, Gynemesh PS had the greatest negative impact on vaginal histomorphology and composition. Compared with sham, implantation with Gynemesh PS caused substantial thinning of the smooth muscle layer (1557 ± 499 μm versus 866 ± 210 μm, P = 0.02), increased apoptosis particularly in the area of the mesh fibres (P = 0.01), decreased collagen and elastin content (20%, P = 0.03 and 43%, P = 0.02, respectively) and increased total collagenase activity (135%, P = 0.01). Glycosaminoglycan, a marker of tissue injury, was highest with Gynemesh PS compared with sham and other meshes (P = 0.01). CONCLUSION: Mesh implantation with the stiffer mesh Gynemesh PS induced a maladaptive remodelling response consistent with vaginal degeneration.
OBJECTIVE: To compare the impact of the prototype prolapse mesh Gynemesh PS with that of two new-generation lower stiffness meshes, UltraPro and SmartMesh, on vaginal morphology and structural composition. DESIGN: A mechanistic study employing a nonhuman primate model. SETTING: Magee-Womens Research Institute at the University of Pittsburgh. POPULATION: Parous rhesus macaques, with similar age, weight, parity and Pelvic Organ Prolapse-Questionnaire scores. METHODS: Following Institutional Animal Care Use Committee approval, 50 rhesus macaques were implanted with Gynemesh PS (n = 12), UltraPro with its blue line perpendicular to the longitudinal axis of vagina (n = 10), UltraPro with its blue line parallel to the longitudinal axis of vagina (n = 8) or SmartMesh (n = 8) via sacrocolpopexy following hysterectomy. Sham-operated animals (n = 12) served as controls. MAIN OUTCOME MEASURES: The mesh-vagina complex was removed after 12 weeks and analysed for histomorphology, in situ cell apoptosis, total collagen, elastin, glycosaminoglycan content and total collagenase activity. Appropriate statistics and correlation analyses were performed accordingly. RESULTS: Relative to sham and the two lower stiffness meshes, Gynemesh PS had the greatest negative impact on vaginal histomorphology and composition. Compared with sham, implantation with Gynemesh PS caused substantial thinning of the smooth muscle layer (1557 ± 499 μm versus 866 ± 210 μm, P = 0.02), increased apoptosis particularly in the area of the mesh fibres (P = 0.01), decreased collagen and elastin content (20%, P = 0.03 and 43%, P = 0.02, respectively) and increased total collagenase activity (135%, P = 0.01). Glycosaminoglycan, a marker of tissue injury, was highest with Gynemesh PS compared with sham and other meshes (P = 0.01). CONCLUSION: Mesh implantation with the stiffer mesh Gynemesh PS induced a maladaptive remodelling response consistent with vaginal degeneration.
Authors: V K Goel; T H Lim; J Gwon; J Y Chen; J M Winterbottom; J B Park; J N Weinstein; J Y Ahn Journal: Spine (Phila Pa 1976) Date: 1991-03 Impact factor: 3.468
Authors: Charles W Nager; Halina Zyczynski; Rebecca G Rogers; Matthew D Barber; Holly E Richter; Anthony G Visco; Charles R Rardin; Heidi Harvie; Dennis Wallace; Susan F Meikle Journal: Female Pelvic Med Reconstr Surg Date: 2016 Jul-Aug Impact factor: 2.091
Authors: Akinjide Akintunde; Kathryn M Robison; Daniel Capone; Laurephile Desrosiers; Leise R Knoepp; Kristin S Miller Journal: J Biomech Eng Date: 2018-11-15 Impact factor: 2.097
Authors: Bryan N Brown; Deepa Mani; Alexis L Nolfi; Rui Liang; Steven D Abramowitch; Pamela A Moalli Journal: Am J Obstet Gynecol Date: 2015-08-07 Impact factor: 8.661