New Zealand white rabbit: a novel model for prolapse mesh implantation via a lumbar colpopexy

  • Katrina M. KnightEmail author
  • Amanda M. Artsen
  • Megan R. Routzong
  • Gabrielle E. King
  • Steven D. Abramowitch
  • Pamela A. Moalli
Original Article


Introduction and hypothesis

New Zealand white rabbits are an inexpensive large-animal model. This study explored the rabbit as a model for mesh-augmented colpopexy using the intra-abdominal vagina. We hypothesized that polypropylene mesh would negatively impact rabbit vaginal smooth muscle (VSM) morphology and contractile function, similar to the nonhuman primate (NHP)—the established model for prolapse mesh evaluation.


Restorelle was implanted onto the vagina of ten rabbits via lumbar colpopexy after a hysterectomy. Ten rabbits served as sham. Twelve weeks post-implantation, the vagina was excised and VSM morphology and vaginal contractility were assessed. Outcome measures were compared using independent samples t and Mann-Whitney U tests with a Bonferroni correction, where appropriate. Results from the rabbits were compared with published NHP data.


Animals had similar age, parity and BMI. VSM was 18% thinner after Restorelle implantation, P = 0.027. Vaginal contractility was 43% decreased in response to 120 mM KCl (P = 0.003), similar to the 46% reduction observed in the NHP vagina implanted with Restorelle (P = 0.027). Three meshes wrinkled in vivo, resulting in dramatic thinning of the underlying vagina in the area of the mesh causing a mesh exposure.


Polypropylene mesh negatively impacts VSM morphology and vaginal contractility in the rabbit, similar to the NHP, suggesting that the rabbit may serve as an alternative large-animal model. The vaginal thinning and appearance of a mesh exposure in the area of a mesh wrinkle suggest the rabbit may also serve as a model for understanding the pathophysiology of mesh exposure.


New Zealand white rabbit Vaginal smooth muscle Pelvic organ prolapse Modified abdominal sacrocolpopexy Lumbar colpopexy Polypropylene mesh 



We are grateful for the financial support from the Department of Defense (DOD) (grant no. W81XWH-16-1-0133). The DOD did not provide any assistance with the study design, the collection, analysis and interpretation of data or in the writing of this report or in the decision to submit the article for publication. Research reported in this publication was also supported by the National Center for Advancing Translational Sciences of the National Institutes of Health under award no. TL1TR001858. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The authors would like to thank Dr. Naoki Yoshimura MD, PhD (Professor of Urology, Pharmacology, and Cell Biology, University of Pittsburgh), for allowing us to use the organ bath system to collect the contractility data reported and Stacy Palcsey for her assistance with this study.


This study was funded by the Department of Defense (grant no. W81XWH-16-1-0133) and the National Center for Advancing Translational Sciences of the National Institutes of Health (award no. TL1TR001858).

Compliance with ethical standards

Conflicts of interest



  1. 1.
    FDA. Surgical mesh for treatment of women with pelvic organ prolapse and stress urinary incontinence: FDA executive summary. 2011.Google Scholar
  2. 2.
    Brown BN, Mani D, Nolfi AL, Liang R, Abramowitch SD, Moalli PA. Characterization of the host inflammatory response following implantation of prolapse mesh in rhesus macaque. Am J Obstet Gynecol. 2015;213(5):668e661–10. Scholar
  3. 3.
    Endo M, Feola A, Sindhwani N, Manodoro S, Vlacil J, Engels AC, et al. Mesh contraction: in vivo documentation of changes in apparent surface area utilizing meshes visible on magnetic resonance imaging in the rabbit abdominal wall model. Int Urogynecol J. 2014:1–7.Google Scholar
  4. 4.
    Feola A, Abramowitch S, Jallah Z, Stein S, Barone W, Palcsey S, et al. Deterioration in biomechanical properties of the vagina following implantation of a high-stiffness prolapse mesh. BJOG Int J Obstet Gynaecol. 2013;120(2):224–32.CrossRefGoogle Scholar
  5. 5.
    Jallah Z, Liang R, Feola A, Barone W, Palcsey S, Abramowitch S, et al. The impact of prolapse mesh on vaginal smooth muscle structure and function. BJOG Int J Obstet Gynaecol. 2015.
  6. 6.
    Liang R, Abramowitch S, Knight K, Palcsey S, Nolfi A, Feola A, et al. Vaginal degeneration following implantation of synthetic mesh with increased stiffness. BJOG Int J Obstet Gynaecol. 2013;120(2):233–43.CrossRefGoogle Scholar
  7. 7.
    Abramowitch SD, Feola A, Jallah Z, Moalli PA. Tissue mechanics, animal models, and pelvic organ prolapse: a review. Eur J Obstet Gynecol Reprod Biol. 2009;144(SUPPL 1):S146–58.CrossRefGoogle Scholar
  8. 8.
    Endo M, Urbankova I, Vlacil J, Sengupta S, Deprest T, Klosterhalfen B, et al. Cross-linked xenogenic collagen implantation in the sheep model for vaginal surgery. Gynecol Surg. 2015;12(2):113–22. Scholar
  9. 9.
    Feola A, Endo M, Urbankova I, Vlacil J, Deprest T, Bettin S, et al. Host reaction to vaginally inserted collagen containing polypropylene implants in sheep. Am J Obstet Gynecol. 2015;212(4):474.e471–8. Scholar
  10. 10.
    Tayrac R, Alves A, Thérin M. Collagen-coated vs noncoated low-weight polypropylene meshes in a sheep model for vaginal surgery. A pilot study. Int Urogynecol J. 2007;18(5):513–20. Scholar
  11. 11.
    Fan X, Wang Y, Wang Y, Xu H. Comparison of polypropylene mesh and porcine-derived, cross-linked urinary bladder matrix materials implanted in the rabbit vagina and abdomen. Int Urogynecol J. 2014;25(5):683–9. Scholar
  12. 12.
    Hilger WS, Walter A, Zobitz ME, Leslie KO, Magtibay P, Cornella J. Histological and biomechanical evaluation of implanted graft materials in a rabbit vaginal and abdominal model. Am J Obstet Gynecol. 2006;195(6):1826–31. Scholar
  13. 13.
    Pierce LM, Grunlan MA, Hou Y, Baumann SS, Kuehl TJ, Muir TW. Biomechanical properties of synthetic and biologic graft materials following long-term implantation in the rabbit abdomen and vagina. Am J Obstet Gynecol. 2009;200(5):549.e541–8. Scholar
  14. 14.
    Pierce LM, Rao A, Baumann SS, Glassberg JE, Kuehl TJ, Muir TW. Long-term histologic response to synthetic and biologic graft materials implanted in the vagina and abdomen of a rabbit model. Am J Obstet Gynecol. 2009;200(5):546.e541–8. Scholar
  15. 15.
    Huffaker RK, Muir TW, Rao A, Baumann SS, Kuehl TJ, Pierce LM. Histologic response of porcine collagen-coated and uncoated polypropylene grafts in a rabbit vagina model. Am J Obstet Gynecol. 2008;198(5):582.e581–7. Scholar
  16. 16.
    Skoczylas LC, Jallah Z, Sugino Y, Stein SE, Feola A, Yoshimura N, et al. Regional differences in rat vaginal smooth muscle contractility and morphology. Reproductive sciences (Thousand Oaks, Calif). 2013;20(4):382–90. Scholar
  17. 17.
    DeLancey JOL, Starr RA. Histology of the connection between the vagina and levator ani muscles. Implications for urinary tract function. Journal of Reproductive Medicine for the Obstetrician and Gynecologist. 1990;35(8):765–71.Google Scholar
  18. 18.
    Goldstein I, Alexander JL. Practical aspects in the management of vaginal atrophy and sexual dysfunction in perimenopausal and postmenopausal women. J Sex Med. 2005;2:154–65. Scholar
  19. 19.
    Boreham MK, Wai CY, Miller RT, Schaffer JI, Word RA. Morphometric analysis of smooth muscle in the anterior vaginal wall of women with pelvic organ prolapse. Am J Obstet Gynecol. 2002;187(1):56–63. Scholar
  20. 20.
    Boreham MK, Wai CY, Miller RT, Schaffer JI, Word RA, Weber A. Morphometric properties of the posterior vaginal wall in women with pelvic organ prolapse. Am J Obstet Gynecol. 2002;187(6):1501–9. Scholar
  21. 21.
    Takacs P, Gualtieri M, Nassiri M, Candiotti K, Medina CA. Vaginal smooth muscle cell apoptosis is increased in women with pelvic organ prolapse. Int Urogynecol J Pelvic Floor Dysfunct. 2008;19(11):1559–64. Scholar
  22. 22.
    Halaska M, Maxova K, Sottner O, Svabik K, Mlcoch M, Kolarik D, et al. A multicenter, randomized, prospective, controlled study comparing sacrospinous fixation and transvaginal mesh in the treatment of posthysterectomy vaginal vault prolapse. Am J Obstet Gynecol. 2012;207(4):301.e301–7. Scholar
  23. 23.
    Jacquetin B, Hinoul P, Gauld J, Fatton B, Rosenthal C, Clavé H, et al. Total transvaginal mesh (TVM) technique for treatment of pelvic organ prolapse: a 5-year prospective follow-up study. Int Urogynecol J. 2013;24(10):1679–86. Scholar
  24. 24.
    Nieminen K, Hiltunen R, Takala T, Heiskanen E, Merikari M, Niemi K, et al. Outcomes after anterior vaginal wall repair with mesh: a randomized, controlled trial with a 3 year follow-up. Am J Obstet Gynecol. 2010;203(3):235.e231–8. Scholar
  25. 25.
    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(19):2016–24. Scholar
  26. 26.
    Feiner B, Maher C. Vaginal mesh contraction: definition, clinical presentation, and management. Obstet Gynecol. 2010;115(2 PART 1):325–30.CrossRefGoogle Scholar
  27. 27.
    Svabik K, Martan A, Masata J, El-Haddad R, Hubka P, Pavlikova M. Ultrasound appearances after mesh implantation—evidence of mesh contraction or folding? Int Urogynecol J. 2011;22(5):529–33. Scholar
  28. 28.
    Nolfi AL, Brown BN, Liang R, Palcsey SL, Bonidie MJ, Abramowitch SD, et al. Host response to synthetic mesh in women with mesh complications. Am J Obstet Gynecol. 2016;215(2):206.e201–8. Scholar
  29. 29.
    Tennyson L, Rytel M, Palcsey S, Meyn L, Liang R, Moalli P. Characterization of the T cell response to polypropylene mesh in women with complications. Am J Obstet Gynecol. 2018.
  30. 30.
    Northington GM, Basha M, Arya LA, Wein AJ, Chacko S. Contractile response of human anterior vaginal muscularis in women with and without pelvic organ prolapse. Reprod Sci. 2011;18(3):296–303. Scholar

Copyright information

© The International Urogynecological Association 2019

Authors and Affiliations

  1. 1.Department of MedicineUniversity of PittsburghPittsburghUSA
  2. 2.Magee-Womens Research InstitutePittsburghUSA
  3. 3.Magee-Womens Research Institute, Department of Obstetrics and Gynecology and Reproductive Sciences at Magee Womens HospitalUniversity of PittsburghPittsburghUSA
  4. 4.Department of BioengineeringUniversity of PittsburghPittsburghUSA

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