International Urogynecology Journal

, Volume 28, Issue 8, pp 1153–1158 | Cite as

Effect of mesh width on apical support after sacrocolpopexy

  • Sunil Balgobin
  • Joseph L. Fitzwater
  • Donald D. McIntire
  • Imelda J. Delgado
  • Clifford Y. Wai
Original Article


Introduction and hypothesis

We evaluated the effect of polypropylene mesh width on vaginal apical support, mesh elongation, and mesh tensile strength for abdominal sacrocolpopexy.


Abdominal sacrocolpopexy was performed on ten cadavers using pieces of polypropylene mesh of width 1, 2, and 3 cm. Weights of 1, 2, 3, and 4 kg were sequentially applied to the vagina. The total distance moved by the vaginal apex, and the amount of stretch of the intervening mesh segment between the sacrum and the vagina were recorded for each width. The failure strengths of additional single and double layer sets of each width were also tested using a tensiometer. Data were analyzed with analysis of variance using a random effects model.


The mean (standard error of the mean) maximum distance moved by the vaginal apex was 4.63 cm (0.37 cm) for the 1 cm mesh compared to 3.67 cm (0.26 cm) and 2.73 cm (0.14 cm) for the 2 and 3 cm meshes, respectively (P < 0.0001). The 1 cm width ruptured during testing in four of the ten cadavers. The results were similar for mesh elongation, with the 1 cm mesh stretching the most and the 3 cm mesh stretching the least. Mesh failure loads for double-layer mesh were 52.9 N (2.5 N), 124.4 N (2.7 N), and 201.2 N (4.5 N) for the 1, 2, and 3 cm meshes, respectively, and were higher than the failure loads for single mesh (P < 0.001).


In a cadaver model, increasing mesh width is associated with better vaginal apical support, less mesh elongation, and higher failure loads. Mesh widths of 2–3 cm provide sufficient repair strength for sacrocolpopexy.


Biomechanics Mesh width Polypropylene mesh Sacrocolpopexy 


Compliance with ethical standards

Financial disclaimer


Conflicts of interest



  1. 1.
    Maher C, Feiner B, Baessler K, Schmid C. Surgical management of pelvic organ prolapse in women. Cochrane Database Syst Rev. 2013(4), CD004014.Google Scholar
  2. 2.
    Nygaard I, Brubaker L, Zyczynski HM, Cundiff G, Richter H, Gantz M, et al. Long-term outcomes following abdominal sacrocolpopexy for pelvic organ prolapse. JAMA. 2013;309:2016–2024.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Nygaard IE, McCreery R, Brubaker L, Connolly A, Cundiff G, Weber AM, et al. Abdominal sacrocolpopexy: a comprehensive review. Obstet Gynecol. 2004;104:805–823.CrossRefPubMedGoogle Scholar
  4. 4.
    O’Sullivan OE, Matthews CA, O’Reilly BA. Sacrocolpopexy: is there a consistent surgical technique? Int Urogynecol J. 2016;27:747–750.CrossRefPubMedGoogle Scholar
  5. 5.
    Iglesia CB, Fenner DE, Brubaker L. The use of mesh in gynecologic surgery. Int Urogynecol J Pelvic Floor Dysfunct. 2013;8:105–115.CrossRefGoogle Scholar
  6. 6.
    US Food and Drug Administration. Update on serious complications associated with transvaginal placement of surgical mesh for pelvic organ prolapse: FDA Safety Communication. 2011. Accessed 21 Dec 2016.
  7. 7.
    Ulrich D, Edwards SL, Alexander DLJ, Rosamilia A, Werkmeister JA, Gargett CE, et al. Changes in pelvic organ prolapse mesh mechanical properties following implantation in rats. Am J Obstet Gynecol. 2016;214:260.e1–260.e8.CrossRefGoogle Scholar
  8. 8.
    Jones KA, Feola A, Meyn L, Abramowitch SD, Moalli PA. Tensile properties of commonly used prolapse meshes. Int Urogynecol J Pelvic Floor Dysfunct. 2009;20:847–853.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Shepherd JP, Feola A, Abramowitch SD, Moalli PA. Uniaxial biomechanical properties of seven different vaginal implanted meshes for pelvic organ prolapse. Int Urogynecol J. 2012;23:613–620.CrossRefPubMedGoogle Scholar
  10. 10.
    Culligan PJ, Salamon C, Priestley JL, Shariati A. Porcine dermis compared with polypropylene mesh for laparoscopic sacrocolpopexy. Obstet Gynecol. 2013;121:143–151.CrossRefPubMedGoogle Scholar
  11. 11.
    Medina CA, Pietro PA, Whitted RW, Penalver M. The use of dura mater allografts for abdominal sacral colpopexy. J Pelvic Surg. 2002;8:247–251.Google Scholar
  12. 12.
    Timmons MC, Addison WA, Addison SB, Cavenar MG. Abdominal sacral colpopexy in 163 women with posthysterectomy vaginal vault prolapse and enterocele: evolution of operative techniques. J Reprod Med. 1992;37:323–327.PubMedGoogle Scholar
  13. 13.
    Deprest J, Zheng F, Konstantinovic M, Spelzini F, Claerhout F, Steensma A, et al. The biology behind fascial defects and the use of implants in pelvic organ prolapse repair. Int Urogynecol J Pelvic Floor Dysfunct. 2006;17:S16–S25.CrossRefPubMedGoogle Scholar
  14. 14.
    LeVeen HH, Barbiero JR. Tissue reaction to plastics used in surgery with special reference to Teflon. Ann Surg. 1949;129:74–84.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    White AB, Karrick KS, Corton MM, McIntire DD, Word RA, Rahn DD, et al. Optimal location and orientation of suture placement in abdominal sacrocolpopexy. Obstet Gynecol. 2009;113:1098–1103.CrossRefPubMedGoogle Scholar
  16. 16.
    Rahn DD, Stone RJ, Vu AK, White AB, Wai CY. Abdominal hysterectomy with or without angle stitch: correlation with subsequent vaginal vault prolapse. Am J Obstet Gynecol. 2008;199:669.e1–669.e4.CrossRefGoogle Scholar
  17. 17.
    Rodeheaver GT, Thacker JG, Owen J, Strauss M, Masterson T, Edlich RF. Knotting and handling characteristics of coated synthetic absorbable sutures. J Surg Res. 1983;35:525–530.CrossRefPubMedGoogle Scholar
  18. 18.
    Barber MD, Maher C. Apical prolapse. Int Urogynecol J. 2013;24:1815–1833.CrossRefPubMedGoogle Scholar
  19. 19.
    Addington WR, Stephens RE, Phelipa MM, Widdicombe JG, Ockey RR. Intra-abdominal pressures during voluntary and reflex cough. Cough. 2008;4:2. doi: 10.1186/1745-9974-4-2.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Rempen A, Kraus M. Measurement of head compression during labor: preliminary results. J Perinat Med. 1991;19:115–120.CrossRefPubMedGoogle Scholar
  21. 21.
    Woodruff AJ, Roth CC, Winters JC. Abdominal sacral colpopexy: surgical pearls and outcomes. Curr Urol Rep. 2007;8:399–404.CrossRefPubMedGoogle Scholar
  22. 22.
    Brizzolara S, Pillai-Allen A. Risk of mesh erosion with sacral colpopexy and concurrent hysterectomy. Obstet Gynecol. 2003;102:306–310.PubMedPubMedCentralGoogle Scholar
  23. 23.
    Iosof CS. Abdominal sacral colpopexy with use of synthetic mesh. Acta Obstet Gynecol Scand. 1993;72:214–217.CrossRefGoogle Scholar
  24. 24.
    Good MM, Abele TA, Balgobin S, Montoya TI, McIntire DD, Corton MM. Vascular and ureteral anatomy relative to the midsacral promontory. Am J Obstet Gynecol. 2013;208:486.e1–486.e7.CrossRefGoogle Scholar
  25. 25.
    Pilsgaard K, Mouritsen L. Follow up after repair of vaginal vault prolapse with abdominal colposacropexy. Acta Obstet Gynecol Scand. 1999;78:66–70.CrossRefPubMedGoogle Scholar
  26. 26.
    Salamon CG, Lewis C, Priestley J, Gurshumov E, Culligan PJ. Prospective study of an ultra-lightweight polypropylene Y mesh for robotic sacrocolpopexy. Int Urogynecol J. 2013;24:1371–1375.CrossRefPubMedGoogle Scholar
  27. 27.
    Schofield ML, Higgs P, Hawnaur JM. MRI findings following laparoscopic sacrocolpopexy. Clin Radiol. 2005;60:333–339.CrossRefPubMedGoogle Scholar

Copyright information

© The International Urogynecological Association 2016

Authors and Affiliations

  • Sunil Balgobin
    • 1
  • Joseph L. Fitzwater
    • 1
  • Donald D. McIntire
    • 1
  • Imelda J. Delgado
    • 2
  • Clifford Y. Wai
    • 1
  1. 1.Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and GynecologyUniversity of Texas Southwestern Medical CenterDallasUSA
  2. 2.Department of Plastic SurgeryUniversity of Texas Southwestern Medical CenterDallasUSA

Personalised recommendations