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Mechanical properties of synthetic implants used in the repair of prolapse and urinary incontinence in women: which is the ideal material?

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Abstract

The authors review the literature concerning all types of synthetics implants used in prolapse repair or the treatment of stress urinary incontinence, and analyze the mechanical properties of and the tolerance to the various products used. Various synthetic implants are also studied, including their advantages and disadvantages, as well as outcome following implantation and tolerance by the host, with respect to the type of product and the type of intervention. A review of current implant products demonstrated that the perfect product does not exist at present. The most promising of theses products for applications in transvaginal surgery to restore pelvic function appears to be the synthetic prostheses made predominantly of polypropylene, which offer mechanical properties of durability and elasticity. Their properties of resistance are undisputed, but it remains to be shown whether they are well tolerated when inserted by the vaginal route. The technical modalities for their use are still under evaluation, which should enable a better identification of the respective indications for these products in prolapse repair and treatment of urinary incontinence by the vaginal route.

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Abbreviations

PP:

Polypropylene

PGA:

Polyglycolic acid

PETP:

Polyethylene terephthalate

PTFE:

Polytetrafluoroethylene

TVT:

Tension-free vaginal tape

References

  1. Pans A, Albert A, Lapière CM, Nusgens B (2001). Biochemical study of collagen in adult groin hernias. J Surg Res 95:107–113

    Article  CAS  PubMed  Google Scholar 

  2. Ulmsten U, Ekman G, Giertz G, Malmstrom A (1987) Different biochemical composition of connective tissue in continent and stress incontinent women. Acta Obstet Gynecol Scand 66:455–457

    PubMed  Google Scholar 

  3. Gilpin SA et al. (1989) The pathogenesis of genitourinary prolapse and stress incontinence of urine. A histological and biochemical study. Br J Obstet Gynaecol 96:15–23

    CAS  PubMed  Google Scholar 

  4. Norton P et al. (1992) Abnormal collagen ratio in women with genitourinary prolapse. Neurourol Urodyn  11: 2–4

    Google Scholar 

  5. Witzel O (1900) Ueber den Verschluss von Bauchwunden und Bruchpforten durch versenkte Silberdrachtnetze. Centralbl Chir Leipz 27:257

    Google Scholar 

  6. Bauer JJ, Salky BA, Gelernt IM (1987) Repair of large abdominal wall defects with expanded polytetrafluoroethylene (PTFE). Ann Surg 206:765–769

    CAS  PubMed  Google Scholar 

  7. Babcock WW (1952) The range of usefulness of commercial stainless steel cloths in general and special forms of surgical practice. Ann West Med Surg 6:15

    Google Scholar 

  8. Goepel R (1928) Der Verschluss von Nabel und Bauchwand hernien unter Verwendung gegliederten Silberdrahtnetze. Münch Med Webnsch 75:127

  9. Morgan JE (1970) A sling operation, using Marlex polypropylene mesh, for treatment of recurrent stress incontinence. Am J Obstet Gynecol 106:369–377

    CAS  PubMed  Google Scholar 

  10. Iosif CS (1993) Abdominal sacral colpopexy with use of synthetic mesh. Acta Obstet Gynecol Scand 72:214–217

    CAS  PubMed  Google Scholar 

  11. Nichols DH (1973) The Mersilene mesh gauze-hammock for severe urinary stress incontinence. Obstet Gynecol 41: 88–93

    CAS  PubMed  Google Scholar 

  12. Stanton SL (1985) Silastic sling for urethral sphincter incompetence in women. Br J Obstet Gynaecol 92:747–750

    CAS  PubMed  Google Scholar 

  13. de Tayrac R, Gervaise A, Fernandez H (2001) Cystocele repair with a fixation-free prosthetic polypropylene mesh. Int Urogynecol J 12 (suppl 3):S92.

    Google Scholar 

  14. Sarsotti C, Lamm M, Testa R (2001) rectocele repair using a prolene mesh in patients with defecatory outlet obstruction. Int Urogynecol J12 (suppl 3):S82

    Google Scholar 

  15. Sarsotti C, Ubertazzi E, Lamm M, Tidone C, Pruneda Paz J, Terta R (2001) The use of heterologous meshes for rectocele repair. Int Urogynecol J12 (suppl 3):S158.

    Google Scholar 

  16. Oliver RF, Grant RA, Kent CM (1972) The fate of cutaneously and subcutaneously implanted trypsin purified dermal collagen in the pig. Br J Exp Pathol 53 :540–549

    Google Scholar 

  17. Chvapil M (1980) Reconstituted collagen. In :Viidick A, Vuust J, eds. Biology of collagen. New York: Academic Press, 1980; 313–323

    Google Scholar 

  18. FitzGerald MP, Mollenhauer J, Brubaker L (2000). The fate of rectus fascia suburethral slings. Am J Obstet Gynecol 183:964–966

    Article  CAS  PubMed  Google Scholar 

  19. Walter AJ, Morse AN, Leslie K, Zobitz M, Hentz JG, Cornella JL (2001) Changes in tensile strength of cadaveric human fascia lata following implantation in a rabbit vagina model. Abstract 43. AUGS Meeting Hilton Head, 18–21 September .

  20. Levasseur JC, Lehn E, Rignier P (1979) Etude expérimentale et utilisation clinique d'un nouveau materiel dans les eviscerations graves post-operatoires. Chirurgie 105 :577–581

    Google Scholar 

  21. Lamb JP, Vitale T, Kamenski DL (1983) Comparative evaluation of synthetic meshes used for abdominal replacement. Surgery 93 :643–648

    Google Scholar 

  22. Tyrell J, Silberman H, Chandrasoma P, Niland H (1989) Absorbable versus permanent mesh in abdominal operations. SGO 168 :227–233

    Google Scholar 

  23. Rath AM, Zhang J, Amouroux J, Chevrel J (1996)  Les prothèses pariétales abdominales. Etude biomécanique et histologique. Chirurgie 121:253–265

    CAS  PubMed  Google Scholar 

  24. Brenner J. Mesh materials in hernia repair. In: Schumpelick V, Wantz GE, eds. Inguinal hernia repair. Expert Meeting on Hernia Surgery, St Moritz, 1994. Basel: Karger, 1995;172–179

  25. Sand PK, Koduri S, Lobel RW et al. (2001) Prospective randomized trial of polyglactin 910 mesh to prevent recurrence of cystoceles and rectoceles. Am J Obstet Gynecol 184:1357–1364.

    Article  CAS  PubMed  Google Scholar 

  26. Weber AM, Walters MD, Piedmonte MR, Ballard LA (2001) Anterior colporrhaphy: a randomized trial of three surgical techniques. Am J Obstet Gynecol 185:1299–1306

    Article  CAS  PubMed  Google Scholar 

  27. Acquaviva D.E, Bourret P (1948) Cure des éventrations par plaques de nylon. Press Med 73 :892

    Google Scholar 

  28. Gibson LD, Stafford CE (1964) Synthetic mesh repair of abdominal wall defects. Am Surg 30:481

    CAS  Google Scholar 

  29. Meyer Ch, Alexiou D, Calderoli H, Hollender LF (1977) Les matériaux de synthèse dans la cure des grandes éventrations abdominales. Enseignements à propos de 78 observations. Ann Chir 31:221–228

    CAS  PubMed  Google Scholar 

  30. Usher FC, Ochsner J, Tuttle LLD Jr (1958) Use of Marlex mesh in the repair of incisional hernias. Am Surgeon 24:969

    CAS  Google Scholar 

  31. Amid PK (1997) Classification of biomaterials and their related complications in abdominal wall hernia surgery. Hernia 1:15–21

    Google Scholar 

  32. Williams DF (1973) The response of the body environment to implants. In: Williams DF, Roaf R, eds. Implants in surgery. Philadelphia: WB Saunders 203–297

  33. Kaupp HA, Matulewicz TJ, Lattimer GL (1979) Graft infection or graft reaction ? Arch Surg 114:1419

    Google Scholar 

  34. Petit J, Stoppa R, Baillet J (1974) Evaluation expérimentale des réactions tissulaires autour des prothèses de la paroi en tulle de Dacron en fonction de la durée d'implantation et du siège en profondeur. J Chir 107:667–672

    CAS  Google Scholar 

  35. Adloff M, Arnaud J-P (1976) Etude expérimentale de la résistance et de la tolerance biologique de matériaux prothétiques utilisés dans la réparation des pertes de substance de la paroi abdominale. Chirurgie 102:390–396

    CAS  PubMed  Google Scholar 

  36. Lamb J.P, Vitale T, Kminski DL (1983) Comparative evaluation of synthetic meshes used for abdominal wall replacement. Surgery 93:643–648

    CAS  PubMed  Google Scholar 

  37. Bhuta I, Dorrough R (1981) Noninfectious fluid collection around velour Dacron graft: Possible allergic reaction. South Med J 74:870

    CAS  PubMed  Google Scholar 

  38. De Clerck LS, Houuthooft D, Vermeylen J, De Schepper A, Stevens WJ (1990) Delayed reaction to a Dacron velour bypass graft. J Cardiovasc Surg 31:124–126

    Google Scholar 

  39. Katz S, Izhar M, Mirelman D (1981) Bacterial adherence to vascular prostheses. A determinant of graft infectivity. J Vasc Surg 194:35–41

    CAS  Google Scholar 

  40. Klinge U, Klosterhalfen B, Müller M, Schumpelick V (1999) Foreign body reaction to meshes used for the repair of abdominal wall hernias. Eur J Surg 165 :665–673

    Google Scholar 

  41. Capozzi JA, Berkenfield JA, Cheaty JK (1988) Repair of inguinal hernia in the adult with prolene mesh. Surg Gynecol Obstet 167:124–128

    CAS  PubMed  Google Scholar 

  42. Stoppa RE, Rives JL, Warlaumont CR (1984) The use of Dacron in the repair of hernias of the groin. Surg Clin North Am 64:269–285

    CAS  PubMed  Google Scholar 

  43. Soler M, Verhaeghe P, Esssomba A, Sevestre H, Stoppa R (1993) Treatment of post operative incisional hernias by a composite prosthesis. Clinical and experimental study. Ann Chir 47:598–608

    CAS  PubMed  Google Scholar 

  44. Amid PK, Shulman AG, Lichtensten IL (1972). A simple staping technique for the prosthetic repair of massive incisional hernias. In: Arregui ME, Nagan RF (eds) Inguinal hernia advances or controversies? Radcliffe Medical Press, Oxford, pp 511–514

  45. Bryans FE (1979) Marlex gauze hammock sling operation with Cooper's ligament attachment in the management of recurrent urinary stress incontinence. Am J Obstet Gynecol 133:292–294

    CAS  PubMed  Google Scholar 

  46. Morgan JE, Farrow GA, Stewart FE (1985) The Marlex sling operation for the treatment of recurrent stress urinary incontinence. Am J Obstet Gynecol 151:224–226

    CAS  PubMed  Google Scholar 

  47. Drutz HP, Buckspan M, Flax S, Mackie L (1990) Clinical and urodynamic re-evaluation of combined abdovaginal Marlex sling operation for recurrent stress urinary incontinence. Int Urogynecol J 1:70–73

    Google Scholar 

  48. Kersey J (1983) The gauze hammock sling operation in the treatment of stress incontinence. Br J Obstet Gynaecol90:945–949

    Google Scholar 

  49. Iosif CS (1985) Sling operation for urinary incontinence. Acta Obstet Gynecol Scand 64:187–190

    CAS  PubMed  Google Scholar 

  50. Young SB, Rosenblatt PL, Pingeton DM (1995) The Mersilene mesh suburethral sling: a clinical and urodynamic evaluation. Am J Obstet Gynecol 173:1719–1726

    CAS  PubMed  Google Scholar 

  51. Addison WA, Livengood CH, Sutton GP, Parker RT (1985) Abdominal sacral colpopexy with Mersilene mesh in the retroperitoneal position in the management of post hysterectomy vaginal vault prolapse and enterocele. Am J Obstet Gynecol 153: 140–146

    CAS  PubMed  Google Scholar 

  52. Creighton SM, Stanton SL (1991) The surgical management of vaginal vault prolapse. Br J Obstet Gynaecol 98:1150–1154

    CAS  PubMed  Google Scholar 

  53. de Vries MJ, van Dessel TH, Drogendijk AC (1995) Short-term results and long-term patients'appraisal of abdominal colpo-sacropexy for treatment of genital and vaginal vault prolapse. Eur J Obstet Gynecol Reprod Biol 59:35–38

    Article  PubMed  Google Scholar 

  54. Summit RL, Bent AE, Ostergard DR (1992) Suburethral sling procedure for genuine stress incontinence and low urethral cloture pressure. A continued experience. Int Urogynecol J 3:18–21

    Google Scholar 

  55. Bent AE, Ostergard DR, Zwick-Zaffuto M (1993) Tissue reaction to expanded polytetrafluoroethylene suburethral sling for urinary incontinence: clinical and histologic study. Am J Obstet Gynecol 169:1198–204

    CAS  PubMed  Google Scholar 

  56. Mouchel J (1990) Traitement chirurgical de l'incontinence d'urine à l'effort chez la femme par soutènement sous-urétral à l'aide d'une bandelette de polytétrafluoroéthylène; à propos de 95 observations. Rev Fr Gynecol Obstet 85:399–406

    CAS  PubMed  Google Scholar 

  57. Debodinance P, De Bièvre P, Parmentier D, Dubrulle R, Querleu D. Crepin G (1994) Les 'aléas' de l'utilisation d'une fronde de Gore-Tex dans le traitement de l'incontinence urinaire d'effort. J Gynecol Obstet Biol Reprod 23:665–670

    CAS  Google Scholar 

  58. Weinberger MW, Ostergard DR (1995) Long-term clinical and urodynamic evaluation of the polytetrafluoroethylene sling for treatment of genuine stress incontinence. Obstet Gynecol 86:92–96

    Article  CAS  PubMed  Google Scholar 

  59. Norris JP, Breslin DS, Staskin DR (1996) Use of synthetic material in sling surgery: A minimal invasive approach. J Endourol 10:227–230

    CAS  PubMed  Google Scholar 

  60. Snyder TE, Karantz KE (1991) Abdominal retroperitoneal sacral colpopexy for correction of vaginal prolapse. Obstet Gynecol 77:944–949

    CAS  PubMed  Google Scholar 

  61. Van Lindert ACM, Groenendijk AG, Scholten PC (1993) Surgical support and suspension of genital prolapse, including preservation of the uterus, using Gore-Tex soft tissue patch: a preliminary report. Eur J Obstet Gynecol Reprod Biol 50:133–139

    PubMed  Google Scholar 

  62. Valailas SR, Stanton SL (1994) Sacrocolpopexy: a retrospective study of a clinician's experience. Br J Obstet Gynaecol 101:518–522

    PubMed  Google Scholar 

  63. Korda A, Peat B, Hunter P (1989) Experience with silastic slings for female urinary incontinence. Aust NZ Obstet Gynaecol 29:150–154

    CAS  Google Scholar 

  64. Richardson DA, Bent AE, Ostergard DR, Cannon D (1984) Delayed reaction to the Dacron buttress used in urethropexy. J Reprod Med 3:689–392

    Google Scholar 

  65. Errando C, Batsta JE, Arano P (1996) Polytetrafluoroethylene sling for failure in female stress incontinence surgery. World J Urol 14:S48–S50

    PubMed  Google Scholar 

  66. Debodinance P, Cosson M, Burlet G (1999) Tolerance of synthetic tissues in touch with vaginal scars: review to the point of 287 cases. Eur J Obstet Gynecol Reprod Biol 87:23–30

    Article  CAS  PubMed  Google Scholar 

  67. Kolmorgen von K, Havenmann O, Siegel W (1980) Duraschingenoperationen und deren Ergebnisse bei der operativen Harninkontinentzbehandlung der Frau. Zbl Gynäkol 102:850–856

    Google Scholar 

  68. Backer KR, Beresford JM, Campbell C (1990) Colposacropexy with Prolene mesh. Surg Gynecol Obstet 171:51–54

    PubMed  Google Scholar 

  69. Fianu S, Sodeberg G (1983) Absorbable polyglactin mesh for retropubic sling operations in female urinary stress incontinence. Gynecol Obstet Invest 16:45–50

    CAS  PubMed  Google Scholar 

  70. Villet R, Van Den Akker M, Salet-Lizee D, Bastide N (1995) Cure de prolapsus par voie abdominale à l'aide d'un treillis de Vicryl composite. J Gynecol Obstet Biol Reprod 24:717–721

    CAS  Google Scholar 

  71. Inglesia CB, Fenner DE, Brubacker L (1997) The use of mesh in gynecologic surgery. Int Urogynecol J 8:105–115

    Google Scholar 

  72. Le Veen HH, Barberio JR (1949) Tissue reaction to plastics used in surgery with special reference to Teflon. Ann Surg 129:74–84

    Google Scholar 

  73. Olsson I, Kroon U (1999) A three-year postoperative evaluation of tension-free vaginal tape. Gynecol Obstet Invest 48:267–269

    CAS  PubMed  Google Scholar 

  74. Meschia M, Pifarotti P, Bernasconi F et al. (2001) Tension-free vaginal tape: analysis of outcomes and complications in 404 stress incontinent women. Int Urogynecol J 12(Suppl 2): S24–S27

    Article  Google Scholar 

  75. Nilsson CG, Kuuva N (2001) The tension-free vaginal tape procedure is successful in the majority of women with indications for surgical treatment of urinary stress incontinence. Br J Obstet Gynaecol 108:414–419

    Article  CAS  Google Scholar 

  76. Tamussino K, Hanzal E, Kölle D, Ralph G, Riss P (2001) The Austrian Tension-free Vaginal Tape registry: an update. Int Urogynecol J 12 (Suppl 3):S22

    Article  Google Scholar 

  77. Flood CG, Drutz HP, Waja L (1998) Anterior colporrhaphy reinforced with Marlex mesh for the treatment of cystoceles. Int Urogynecol J 9:200:4

    Google Scholar 

  78. Julian TM (1996) The efficacy of Marlex mesh in the repair of severe recurrent vaginal prolapse of the anterior midvaginal wall. Am J Obstet Gynecol 173:1472–1475

    Google Scholar 

  79. Goh JTW, Dwyer PL (2001) Effectiveness and safety of polypropylene mesh in vaginal prolapse surgery. Int Urogynecol J 12 (Suppl 3):S90

    Google Scholar 

  80. Adile B, Cucinella G, Gugliotta A, Lo Bue S, Grifo S (2001) Tension-free cystocele repair. Two years' follow-up. Int Urogynecol J 12 (Suppl 3):S92

    Google Scholar 

  81. Nicita G (1998) A new operation for genitourinary prolapse. J Urol 160:741–745

    CAS  PubMed  Google Scholar 

  82. Choe Jong M, Ogan K, Battino BS (2000) Antimicrobial mesh versus vaginal wall sling: a comparative outcomes analysis. J Urol 163:1829–1834

    CAS  PubMed  Google Scholar 

  83. Mage Ph (1999) L'interposition d'un treillis synthétique dans la cure par voie vaginale des prolapsus génitaux. J Gynecol Obstet Biol Reprod 28:825–829

    CAS  Google Scholar 

  84. Migliari R, Usai E (1999) Treatment results using a mixed fiber mesh in patients with grade IV cystocele. J Urol 161:1255–1258

    CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Pôle de Chirurgie Gynécologique, Hôpital Jeanne de Flandre, Centre Hospitalier, Régional Universitaire de Lille, 59037, Lille, France

    Michel Cosson, Malik Boukerrou, M. P. Chauvet, Gilles Crépin & Anne Ego

  2. Service de Gynécologie Obstétrique, Centre Hospitalier de Dunkerque, 43 rue des Pinsons, 59430, Saint Pol sur Mer, France

    Philippe Debodinance

  3. Laboratoire Matériaux et Technologies Nouvelles, Institut Catholique des Arts et Métiers de Lille, 6 rue Auber, 59046, Lille, France

    Pierre Lobry

Authors
  1. Michel Cosson
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  2. Philippe Debodinance
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  3. Malik Boukerrou
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  4. M. P. Chauvet
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  5. Pierre Lobry
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  6. Gilles Crépin
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  7. Anne Ego
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Corresponding author

Correspondence to Philippe Debodinance.

Additional information

Editorial Comment: This is a timely review of an issue that concerns every reconstructive surgeon. Although it is widely recognized that the ideal reconstructive material does not exist, it is worthwhile to understand the properties, limitations and efficacy evidence for currently available materials

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Cosson, M., Debodinance, P., Boukerrou, M. et al. Mechanical properties of synthetic implants used in the repair of prolapse and urinary incontinence in women: which is the ideal material?. Int Urogynecol J 14, 169–178 (2003). https://doi.org/10.1007/s00192-003-1066-z

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  • DOI: https://doi.org/10.1007/s00192-003-1066-z

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