3 Mid-term outcomes following sub-urethral synthetic sling removal in women

Abstract

INTRODUCTION AND OBJECTIVES: Midurethral slings are most commonly performed procedure for treatment of Stress Urinary incontinence (SUI). With the limitations attributed to synthetic materials, there continues to be an unmet for improved biomaterials that exhibits the attributes of synthetic material and potentially avoids the negative aspects. Our aim is to examine the biocompatibility of our woven collagen mesh with different crosslinking: Genipin and 1-ethyl-3-dimethylaminopropyl carbodiimide & N-hydroxy succinimide (EDC); against commonly used biomaterials (Prolene and xenograft). METHODS: Collagen solution derived from bovine corium was electrochemically aligned into threads and crosslinked with either Genipin or EDC, then woven into a macroporous mesh. A total of 15 Sprague Dawely rats were randomly grouped into 3 time points: 2 weeks, 8 weeks and 20 weeks. Four different scaffolds were implanted subcutaneously in the abdomen per animal, one each of 1 x 1 cm mesh of Xenmatrix, Prolene, Genipin collagen and EDC collagen. At respective time points, scaffolds were harvested and fixed for a week then sent for histology. Scoring was done by senior pathologist in accordance with ISO 10399. Slides were also scanned for image analysis using ImageJ. Statistical analysis was done using IBM SPSS software. RESULTS: There is no significant acute or chronic inflammation in all materials. Collagen mesh presented favorable biocompatibility scores comparable to Prolene at all time points. Xenmatrix meshes were totally encapsulated and lacked tissue integration with no evidence of cellular infiltration, neovascularization or collagen deposition inside the material at all time points. (see Table 1 for complete results). Although significant microscopic degradation of collagen threads over time, the rate of collagen remodeling recovered collagen density at 5 months (figure 1). CONCLUSIONS: Macroporous Collagen mesh allowed tissue integration & new collagen deposition comparable to Prolene mesh. Thus, our novel mesh has a promising potential in incontinence and pelvic floor reconstruction. Source of Funding: none