Ultrasound appearances after mesh implantation—evidence of mesh contraction or folding?
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Introduction and hypothesis
Polypropylene meshes are frequently used in abdominal and vaginal reconstructive surgery. Recently, several authors have claimed that mesh-associated complications may be linked to mesh shrinkage. We have performed a prospective study with postoperative follow-up by ultrasound examination at two time points after Prolift anterior implantation to assess changes in the ultrasound appearance of mesh implants over time.
We assessed 36 patients who had undergone mesh implantation with Prolift anterior™ mesh for the correction of symptomatic anterior vaginal wall prolapse. During the surgery, we measured the actual midline length of the mesh (initial length). On the fourth postoperative day, we performed a vaginal ultrasound examination (US) to measure mesh length in the midsagittal plane. A second US was performed 3–5 months after surgery to repeat this measurement.
There was a significant difference in mesh length determined before and 4 days after surgery (90.3 vs. 57.1 mm, P = <0.0001) indicating intraoperative folding. On comparing early and late postoperative ultrasound measurements, there was a reduction in length from 57.1 to 48.3 mm (P < 0.0001), indicating possible shrinkage or retraction.
Intraoperative folding seems to be responsible for a large part of the difference between preoperative (in vitro) and postoperative (US) measurements of mesh dimensions, suggesting that surgical techniques may require adjustment.
KeywordsProlift anterior Mesh shrinking Mesh retraction Vaginal ultrasound Vaginal surgery
Pelvic organ prolapse quantification system
This work was supported by the Grant Agency of the Ministry of Health of the Czech Republic, grant NR/9216-3.
Conflicts of interest
A. Martan provides consultation for Gynecare, Bard, and AMS.
- 3.Letouzey V, De Tayrac R, Deffieux X, Fernandez H (2008) Long-term anatomical and functional results after trans-vaginal cystocele repair using a tension-free polypropylene mesh. Int Urogynecol J Pelvic Floor Dysfunct 19:S82–S83Google Scholar
- 6.Mamy L, Letouzey J, Lavigne J, Garric X, Mares P, De Tayrac R (2009) Correlation between contraction and infection of implanted synthetic meshes, using an animal model of mesh infection. Int Urogynecol J Pelvic Floor Dysfunct 20:S167Google Scholar
- 9.Konstantinovic ML, Pille E, Malinowska M, Verbeken E, De Ridder D, Deprest J (2007) Tensile strength and host response towards different polypropylene implant materials used for augmentation of fascial repair in a rat model. Int Urogynecol J Pelvic Floor Dysfunct 18:619–626PubMedCrossRefGoogle Scholar
- 13.Debodinance P, Berrocal J, Clave H, Cosson M, Garbin O, Jacquetin B, Rosenthal C, Salet-Lizee D, Villet R (2004) Changing attitudes on the surgical treatment of urogenital prolapse: birth of the tension-free vaginal mesh. J Gynecol Obstet Biol Reprod (Paris) 33:577–588Google Scholar
- 14.Svabik K, Martan A, Masata J, El Haddad J (2009) Vaginal mesh shrinking—ultrasound assessment and quantification. Int Urogynecol J Pelvic Floor Dysfunct 20:S166Google Scholar