Each type of human cadaveric fascia and porcine allografts showed a marked decrease (60 % to 89 % ) in tensile strength and stiffness from baseline. Polypropylene mesh and autologous fascia did not differ in tensile strength from baseline. Polypropylene mesh increased in stiffness from baseline. Autologous fascia and small intestinal submucosa demonstrated a 41 % and 50 % decrease in surface area, respectively, at 12 weeks.
To our knowledge the relative contribution of biomechanical properties of sling material to the success of anti-incontinence surgery is unknown. However, rapid loss of tensile strength and stiffness in porcine and cadaveric materials may contribute to the early re-emergence of symptoms following successful sling surgery. The results of this study add scientific validity to the increasing use of synthetics in anti-incontinence surgery. Urologists selecting a sling material should be aware of its time dependent biomechanical fate relative to other sling materials.
PUBOVAGINAL SLING USING CADAVERIC FASCIA AND BONE ANCHO... The Journal of Urology |
PUBOVAGINAL SLING USING CADAVERIC FASCIA AND BONE ANCHORS: DISAPPOINTING EARLY RESULTS The Journal of Urology, Volume 165, Issue 5, May 2001, Pages 1605-1611 JOSEPH M. CARBONE, ELIZABETH KAVALER, JIM C. HU, SHLOMO RAZ Abstract PurposePubovaginal sling procedures offer highly effective treatment for patients with female stress urinary incontinence. A recent modification of this technique is the use of cadaveric fascia lata as a sling material supported with titanium anchors placed bilaterally in the pubic bone. We reviewed our experience with this procedure and assessed our outcome.Materials and MethodsA total of 154 consecutive patients underwent a bone anchored, cadaveric fascia pubovaginal sling procedure by a single surgeon from July 1998 to June 1999. All patients were evaluated preoperatively with a detailed history, pelvic examination and radiographic or multichannel video urodynamic studies to diagnose stress urinary incontinence. Our technique begins with the nonincision placement of titanium bone anchors transvaginally into the pubic bone bilaterally. A 2 cm. wide tunnel is created bluntly beneath the vaginal epithelium between the 2 puncture sites with a right angle clamp. A 2 × 7 cm. strip of cadaveric fascia is then passed through the tunnel, into the retropubic space and secured to 2-0 polypropylene sutures attached to the anchors. After securing the sling, the transvaginal puncture sites are closed with 2-0 polyglactin sutures. Patients were seen postoperatively at 6 weeks, and 3 and 6-month followup. Patient age averaged 60 years (range 38 to 85), with an overall average length of followup from surgery of 10.6 months (range 6 to 16). All patients were mailed a self-administered questionnaire and participated in a telephone interview with an office nurse to retrospectively assess outcome and evaluate for recurrent stress urinary incontinence. Recurrent stress urinary incontinence was graded as 0—none, 1—rare, 2—moderate and 3—severe. Repeat pubovaginal sling procedure that was performed in patients with grades 2 to 3 stress urinary incontinence was considered a failure for the purpose of our study. ResultsOf all 154 patients 58 (37.6 % ) had recurrent moderate to severe (grades 2 to 3) stress urinary incontinence at followup. A total of 26 patients underwent a second pubovaginal sling procedure for a reoperation rate of 16.9 % . Intraoperative findings at reoperation revealed the titanium anchors to be in position, the polypropylene sutures to be intact, and retropubic fibrosis and scarring of the urethropelvic ligament suggesting appropriate retropubic placement of the sling in all cases. Uniformly all allogenic cadaveric fascia used for sling material appeared to be fragmented, attenuated or simply absent. Average time to reoperation was 9 months (range 3 to 15). ConclusionsEarly results using a bone anchored cadaveric fascia pubovaginal sling procedure were discouraging. Based on findings at reoperation, we attribute this result to the failure of our sling material and have abandoned the use of cadaveric fascia allografts in all pubovaginal slings at our institution. Purchase PDF (841 K) |
PORCINE DERMIS INTERPOSITION GRAFT FOR REPAIR OF HIGH G... The Journal of Urology |
PORCINE DERMIS INTERPOSITION GRAFT FOR REPAIR OF HIGH GRADE ANTERIOR COMPARTMENT DEFECTS WITH OR WITHOUT CONCOMITANT PELVIC ORGAN PROLAPSE PROCEDURES The Journal of Urology, Volume 171, Issue 4, April 2004, Pages 1581-1584 ALEX GOMELSKY, DELBERT C. RUDY, ROGER R. DMOCHOWSKI Abstract ABSTRACTPurposeRecent literature suggests that graft interposition may decrease the incidence of cystocele recurrence. We describe our experience with porcine dermis interposition grafts for the repair of high grade cystoceles. |
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