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Lipetskaia L, Gonzalez RR, Wu JM, Northington GM, Henley BR, Lane F, Brucker BM, Jarnagin B, Rosenblatt PL. 36-Month Prospective Study of Transvaginal Bovine Graft versus Native Tissue Repair for the Treatment of Pelvic Organ Prolapse. Urology 2022; 167:234-240. [PMID: 35716871 DOI: 10.1016/j.urology.2022.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 05/31/2022] [Accepted: 06/01/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE(S) To compare the safety and effectiveness of dermal bovine transvaginal graft, Xenform, to native tissue in the surgical treatment of anterior and/or apical pelvic organ prolapse. This study was designed in conjunction with FDA requirements. METHODS This was a prospective, non-randomized, parallel cohort, multi-center trial. The primary objective was to demonstrate non-inferiority between transvaginal graft and native tissue repair at 36 months compared to baseline. Treatment success was based on a composite of objective and subjective measures. The co-primary outcome was the rate of serious device- or procedure-related adverse events. A total of 228 patients at 25 sites were included in the study arm and 485 patients underwent native tissue repair. Propensity score stratification was applied to achieve balance between treatment groups. Study outcomes were compared in per protocol and intent-to-treat analysis. RESULTS The primary outcome, treatment success at 36 months, was 83.6% (191/228) for transvaginal graft and 80.5% (390/485) native tissue repair (0.2%, 90%CI [-5.6%, 5.9%]), demonstrating non-inferiority at a preset margin of -12%. The overall rate of severe adverse events was 5.3% (12/228) in transvaginal graft vs 2.7% (13/485) in native tissue repair groups. The study group demonstrated non-inferiority in serious adverse events at the preset margin of 11.6% (2.0%, 90%CI [-0.8%, 4.7%]). There were no reports of graft erosion, and graft exposure rates were low (0.9% [2/228]). CONCLUSIONS Transvaginal repair of anterior and/or apical prolapse with a biological graft is non-inferior to traditional native tissue repair in effectiveness and safety at 36 months.
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Affiliation(s)
- Lioudmila Lipetskaia
- Program Director, Female Pelvic Medicine & Reconstructive Surgery Fellowship, Department of Obstetrics and Gynecology, Cooper University Health Care, Assistant Professor Cooper Medical School of Rowan University, 3 Cooper Plaza Suite #220, Camden, NJ 08103.
| | - Ricardo R Gonzalez
- Program Director, Urology Fellowship in Female Pelvic Medicine & Reconstructive Surgery, Weill Cornell College of Medicine, Houston Methodist Hospital Academic Institute, 6560 Fannin Street, Suite 2100, Houston, TX 77030
| | - Jennifer M Wu
- Interim Vice Dean for Academic Affairs, Professor, Department of Obstetrics and Gynecology, Division of Urogynecology and Reconstructive Pelvic Surgery, University of North Carolina at Chapel Hill, 4030 Bondurant Hall, Campus Box 7000, Chapel Hill, NC 27599
| | - Gina M Northington
- Associate Professor and Director, Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Gynecology and Obstetrics, Emory University School of Medicine, 100 Woodruff Circle, Atlanta, GA 30322
| | - Barbara R Henley
- Section Chief & Associate Professor, Female Pelvic Medicine & Reconstructive Surgery, Department of Obstetrics & Gynecology, Medical College of Georgia at Augusta University, 1120 15th Street, BB 7514, Augusta, GA 30912
| | - Felicia Lane
- Division Director and Urogynecology Fellowship Director, Department of Obstetrics and Gynecology, University of California, Irvine, 333 City Blvd W Suite 1400, Orange, CA 92868
| | - Benjamin M Brucker
- Director, Division of Female Pelvic Medicine & Reconstructive Surgery and Neurourology, Program Director, FPMRS Fellowship, Departments of Urology and Obstetrics & Gynecology, New York University, Langone Health, 550 First Avenue, New York, NY 10016
| | - Barry Jarnagin
- Medical Director, Center for Pelvic Health, 100 Covey Drive, Suite 205, Franklin, TN 37067
| | - Peter L Rosenblatt
- Director of Urogynecology, Boston Urogynecology Associates / Mount Auburn Hospital, Assistant Professor of Obstetrics, Gynecology & Reproductive Biology, Harvard Medical School, 725 Concord Avenue, Suite 3500, Cambridge, MA 02138
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Alexandridis V, Teleman P, Rudnicki M. Efficacy and safety of pelvic organ prolapse surgery with porcine small intestinal submucosa graft implantation. Eur J Obstet Gynecol Reprod Biol 2021; 267:18-22. [PMID: 34689022 DOI: 10.1016/j.ejogrb.2021.10.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 09/16/2021] [Accepted: 10/10/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The ideal implant material for the surgical repair of pelvic organ prolapse in women is yet to be found. This retrospective study aims to evaluate a porcine small intestinal submucosa (SIS) graft (Surgisis™). STUDY DESIGN We reviewed the medical records of women that were operated upon for pelvic organ prolapse using implantation of SIS graft and we examined the short-term complications and recurrence rates. RESULTS A total of 155 surgical procedures were reviewed. SIS graft was placed in the anterior, posterior and middle compartments in 93 (60%), 71 (45.8%) and 13 (8.4%) cases, respectively. At three-month follow-up, 22.6% of anterior graft repairs displayed anatomical recurrence (POP-Q stage ≥ 2), compared to 4.8% of posterior and none of the middle compartment graft repairs. During the three postoperative months, 56% of the women were recorded with complications, mostly urinary retention (19%) and pain (12%). The incidence of grade III complications was 5.3%. Persistent complications at three months were observed in 28% of all cases. Logistic regression analysis showed that previous prolapse surgery at the same compartment was a significant predictor for recurrence of prolapse after SIS graft application, whereas lower age, smoking and longer duration of surgery were significant predictors for the development of complications. Younger women had higher risk of developing pain postoperatively. CONCLUSION Pain and urinary tract symptoms hold a central position in the complications profile of SIS graft-augmented prolapse surgery. The relatively high recurrence rates do not suggest a clear benefit from SIS graft use.
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Affiliation(s)
- Vasileios Alexandridis
- Department of Clinical Sciences, Lund University, Sweden; Department of Obstetrics and Gynecology, Skane University Hospital, Sweden.
| | - Pia Teleman
- Department of Clinical Sciences, Lund University, Sweden; Department of Obstetrics and Gynecology, Skane University Hospital, Sweden
| | - Martin Rudnicki
- Department of Obstetrics and Gynecology, Odense University Hospital, Odense, Denmark
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Spelzini F, Manodoro S, Frigerio M, Nicolini G, Maggioni D, Donzelli E, Altomare L, Farè S, Veneziano F, Avezza F, Tredici G, Milani R. Stem cell augmented mesh materials: an in vitro and in vivo study. Int Urogynecol J 2014; 26:675-83. [PMID: 25416022 DOI: 10.1007/s00192-014-2570-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2014] [Accepted: 11/04/2014] [Indexed: 02/04/2023]
Abstract
INTRODUCTION AND HYPOTHESIS To test in vitro and in vivo the capability of mesh materials to act as scaffolds for rat-derived mesenchymal stem cells (rMSCs) and to compare inflammatory response and collagen characteristics of implant materials, either seeded or not with rMSCs. METHODS rMSCs isolated from rat bone marrow were seeded and cultured in vitro on four different implant materials. Implants showing the best rMSC proliferation rate were selected for the in vivo experiment. Forty-eight adult female Sprague-Dawley rats were randomly divided into two treatment groups. The implant of interest-either seeded or not with rMSCs-was laid and fixed over the muscular abdominal wall. Main outcome measures were: in vitro, proliferation of rMSCs on selected materials; in vivo, the occurrence of topical complications, the evaluation of systemic and local inflammatory response and examination of the biomechanical properties of explants. RESULTS Surgisis and Pelvitex displayed the best cell growth in vitro. At 90 days in the rat model, rMSCs were related to a lower count of neutrophil cells for Pelvitex and a greater organisation and collagen amount for Surgisis. At 7 days Surgisis samples seeded with rMSCs displayed higher breaking force and stiffness. CONCLUSIONS The presence of rMSCs reduced the systemic inflammatory response on synthetic implants and improved collagen characteristics at the interface between biological grafts and native tissues. rMSCs enhanced the stripping force on biological explants.
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Affiliation(s)
- Federico Spelzini
- Department of Obstetrics and Gynaecology, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
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Boennelycke M, Gras S, Lose G. Tissue engineering as a potential alternative or adjunct to surgical reconstruction in treating pelvic organ prolapse. Int Urogynecol J 2012; 24:883. [PMID: 22940843 DOI: 10.1007/s00192-012-2022-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Cell-based tissue engineering strategies could potentially provide attractive alternatives to surgical reconstruction of native tissue or the use of surgical implants in treating pelvic organ prolapse (POP). METHODS Based on a search in PubMed, this review focuses on candidate cell types, scaffolds, and trophic factors used in studies examining cell-based tissue engineering strategies to treat POP, stress urinary incontinence (SUI), and the closely related field of hernias. RESULTS In contrast to the field of SUI, the use of cell-based tissue engineering strategies to treat POP are very sparsely explored, and only preclinical studies exist. CONCLUSION The available evidence suggests that the use of autologous muscle-derived cells, fibroblasts, or mesenchymal stem cells seeded on biocompatible, degradable, and potentially growth-promoting scaffolds could be an alternative to surgical reconstruction of native tissue or the use of conventional implants in treating POP. However, the vagina is a complex organ with great demands of functionality, and the perfect match of scaffold, cell, and trophic factor has yet to be found and tested in preclinical studies. Important issues such as safety and economy must also be addressed before this approach is ready for clinical studies.
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Affiliation(s)
- M Boennelycke
- Department of Obstetrics and Gynecology, Copenhagen University Hospital, Herlev, Denmark
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Boennelycke M, Gras S, Lose G. Tissue engineering as a potential alternative or adjunct to surgical reconstruction in treating pelvic organ prolapse. Int Urogynecol J 2012; 24:741-7. [PMID: 22940843 DOI: 10.1007/s00192-012-1927-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2012] [Accepted: 08/11/2012] [Indexed: 12/11/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Cell-based tissue engineering strategies could potentially provide attractive alternatives to surgical reconstruction of native tissue or the use of surgical implants in treating pelvic organ prolapse (POP). METHODS Based on a search in PubMed, this review focuses on candidate cell types, scaffolds, and trophic factors used in studies examining cell-based tissue engineering strategies to treat POP, stress urinary incontinence (SUI), and the closely related field of hernias. RESULTS In contrast to the field of SUI, the use of cell-based tissue engineering strategies to treat POP are very sparsely explored, and only preclinical studies exist. CONCLUSION The available evidence suggests that the use of autologous muscle-derived cells, fibroblasts, or mesenchymal stem cells seeded on biocompatible, degradable, and potentially growth-promoting scaffolds could be an alternative to surgical reconstruction of native tissue or the use of conventional implants in treating POP. However, the vagina is a complex organ with great demands of functionality, and the perfect match of scaffold, cell, and trophic factor has yet to be found and tested in preclinical studies. Important issues such as safety and economy must also be addressed before this approach is ready for clinical studies.
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Affiliation(s)
- M Boennelycke
- Department of Obstetrics and Gynecology, Copenhagen University Hospital, Herlev, Denmark
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Armitage S, Seman EI, Keirse MJNC. Use of surgisis for treatment of anterior and posterior vaginal prolapse. Obstet Gynecol Int 2012; 2012:376251. [PMID: 22291710 PMCID: PMC3265103 DOI: 10.1155/2012/376251] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2011] [Accepted: 11/24/2011] [Indexed: 11/21/2022] Open
Abstract
Aim. To evaluate the anatomical success and complication rate of Surgisis in the repair of anterior and posterior vaginal wall prolapse. Methods. A retrospective review of 65 consecutive Surgisis prolapse repairs, involving the anterior and/or posterior compartment, performed between 2003 and 2009, including their objective and subjective success rates using the pelvic organ prolapse quantification (POPQ) system. Results. The subjective success rate (no symptoms and no bulge beyond the hymen) was 92%, and the overall objective success rate (no subsequent prolapse in any compartment) was 66% (43 of 65). The overall reoperation rate for de novo and recurrent prolapse was 7.7% with 3 women undergoing repeat surgery at the same site (anterior compartment). No long-term complications occurred. Conclusions. Surgisis has a definite role in the surgical treatment of prolapse. It may decrease recurrences seen with native tissue repair and long-term complications of synthetic mesh. Its use in posterior compartment repair in particular is promising.
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Affiliation(s)
- Sara Armitage
- Department of Obstetrics, Gynaecology and Reproductive Medicine, Flinders Medical Centre and Flinders University, Adelaide, SA 5042, Australia
- Geralton Regional Hospital, 51-85 Shenton Street, Geralton, WA 6531, Australia
| | - Elvis I. Seman
- Department of Obstetrics, Gynaecology and Reproductive Medicine, Flinders Medical Centre and Flinders University, Adelaide, SA 5042, Australia
| | - Marc J. N. C. Keirse
- Department of Obstetrics, Gynaecology and Reproductive Medicine, Flinders Medical Centre and Flinders University, Adelaide, SA 5042, Australia
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Bibliography. Female urology. Current world literature. Curr Opin Urol 2011; 21:343-6. [PMID: 21654401 DOI: 10.1097/mou.0b013e3283486a38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Karp DR, Peterson TV, Mahdy A, Ghoniem G, Aguilar VC, Davila GW. Biologic grafts for cystocele repair: does concomitant midline fascial plication improve surgical outcomes? Int Urogynecol J 2011; 22:985-90. [DOI: 10.1007/s00192-011-1408-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2011] [Accepted: 03/10/2011] [Indexed: 11/24/2022]
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Use of Surgisis mesh in the management of polypropylene mesh erosion into the vagina. Int Urogynecol J 2010; 22:41-6. [PMID: 20700727 DOI: 10.1007/s00192-010-1234-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2009] [Accepted: 07/23/2010] [Indexed: 10/19/2022]
Abstract
INTRODUCTION AND HYPOTHESIS mesh in pelvic reconstructive surgery is being used increasingly in clinical practice. Complications such as mesh erosion and dyspareunia can cause significant patient morbidity. In cases where vaginal mesh erosions are large or multifocal resulting in inadequate healthy epithelium for repair, this may lead to recurrent mesh erosion or vaginal stenosis. METHOD nine patients with synthetic mesh erosion who failed to respond to conservative measures were managed surgically with Surgisis. RESULTS the median time at which patients presented with mesh erosion was 12 weeks. The size of erosion ranged from 1 to 4 cm in diameter. At follow-up, five patients were cured, three still had evidence of mesh erosion although the overall defects were smaller, and one patient required further surgery. CONCLUSION with mesh erosion being a troublesome reality following insertion of synthetic mesh repairs, Surgisis may prove to be a useful option in the treatment of large vaginal mesh defects.
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