The American Urogynecologic Society/The Society of Gynecologic Surgeons
Histopathologic changes of porcine dermis xenografts for transvaginal suburethral slings

https://doi.org/10.1016/j.ajog.2004.11.044Get rights and content

Objective

The purpose of this study was to examine the histopathologic changes of HMDI (Hexamethylene di-isocyanate) cross-linked porcine dermis grafts used for suburethral sling surgery.

Study design

Twelve patients underwent reoperation with graft removal for urinary retention or recurrent stress urinary incontinence after transvaginal sling surgery. Tissue specimens were available for pathologic evaluation in 7 patients. Graft specimens underwent histologic preparation including hematoxylin and eosin staining. A single pathologist reviewed the slides blinded to clinical outcomes.

Results

Histopathologic analyses revealed only limited collagen remodeling, and evidence of a foreign body type reaction was present in some specimens. In cases of recurrent stress incontinence, implants appeared to be completely replaced by dense fibroconnective tissue and moderate neovascularization without evidence of inflammation or graft remnants.

Conclusion

HMDI cross-linked porcine dermal collagen implants result in variable tissue reactions that may have unpredictable clinical outcomes in different patients, raising questions about the overall tolerability and efficacy of these grafts in pelvic reconstructive surgery.

Section snippets

Patients

Twelve of 66 subjects who previously underwent Cooper's ligament slings with porcine dermal implants have undergone reoperation for sling revision. At the time of reoperation, grafts were visible in all subjects, and biopsies were sent in 7 subjects for pathologic evaluation. Six of these specimens were available for histopathologic analysis. Office charts and operative reports were reviewed after Institutional Review Board approval.

Implant processing

Pelvicol™ is a collagen matrix manufactured using a process

Clinical characteristics

We have used porcine dermis xenografts in 66 transvaginal sling procedures between November 2001 and May 2003. Twelve subjects underwent reoperation, representing 18% of the total cohort who had xenografts placed. Ten subjects had urinary retention requiring prolonged catheterization, and 2 women cured on postoperative urodynamics 14 weeks after surgery had recurrent urodynamic stress incontinence. Indications for urethrolysis included complete urinary retention, worsening urge incontinence, or

Comment

There is considerable controversy in the literature regarding the choice of material for sling procedures. Although many authors have described failure rates for sling procedures, few have described the associated in vivo histologic changes and correlated them with clinical outcomes. High complication rates associated with synthetic materials,13, 14 and the increased operative time and prolonged recovery associated with harvesting fascia lata have limited their usage.4, 15, 16 The durability of

References (25)

Cited by (57)

  • Infection susceptibility of crosslinked and non-crosslinked biological meshes in an experimental contaminated environment

    2015, American Journal of Surgery
    Citation Excerpt :

    Crosslinking appears to decrease the pore size of biological meshes to a pore size small enough to provide a suitable housing for bacteria while preventing access of macrophages, fibroblasts, blood vessels, and collagen fibers into the pores.31,32 This may lead to encapsulation rather than remodeling of the mesh.33,34 However, not all crosslinked meshes have similar densities of crosslinking because of differences in processing.

  • Host Response to Biomaterials for Pelvic Floor Reconstruction

    2015, Host Response to Biomaterials: The Impact of Host Response on Biomaterial Selection
View all citing articles on Scopus

Presented at the Joint Scientific Meeting of the Society of Gynecologic Surgeons and the American Urogynecologic Society, San Diego, Calif, July 29-31, 2004.

View full text