PD05-07 IMMUNOFLUORESCENCE LOCALIZATION OF BACTERIAL BIOFILMS ON EXPLANTED TRANSVAGINAL MESH SLINGS REMOVED FOR CHRONIC PAIN

Abstract

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Female Incontinence: Therapy I1 Apr 2018PD05-07 IMMUNOFLUORESCENCE LOCALIZATION OF BACTERIAL BIOFILMS ON EXPLANTED TRANSVAGINAL MESH SLINGS REMOVED FOR CHRONIC PAIN Victoria Scott, A. Lenore Ackerman, Guo Liu, Wenyuan Shi, and Shlomo Raz Victoria ScottVictoria Scott More articles by this author , A. Lenore AckermanA. Lenore Ackerman More articles by this author , Guo LiuGuo Liu More articles by this author , Wenyuan ShiWenyuan Shi More articles by this author , and Shlomo RazShlomo Raz More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.415AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The development of delayed, severe pelvic pain after the transvaginal placement of a mesh sling has been observed in patients who lack overt pathology at the surgical site (e.g. erosion or nerve entrapment). We previously demonstrated that proinflammatory bacteria can be seen in mesh explants from these patients. In this study, we sought to evaluate the localization of these bacteria and examine their relationship to host inflammatory processes. METHODS Mesh sling segments and the surrounding tissue removed from patients with delayed onset of pain and no evidence of vaginal mesh erosion were fixed in paraformaldehyde and analyzed using a combination of immunofluorescence and fluorescence in situ hybridization (FISH) with a bacteria-specific probe (EUB338) as well as by H&E microscopic histology. These were compared to mesh segments removed for isolated urinary retention and no pain or erosion, which served as negative controls. RESULTS By histology, 86% (129/150) of patients with chronic pain exhibited histologic evidence of moderate-severe, macrophage-predominant chronic inflammation, in contrast to the fibrosis seen in patients with retention. FISH staining allowed us to localize a high concentration of bacterial communities on the surface of mesh fibers in patients with chronic pain. Isolated bacteria were noted in vaginal tissue surrounding the mesh as well as accumulating in peri-mesh macrophages. The negative control did not show any bacteria on the mesh or in the surrounding tissue. CONCLUSIONS These findings confirm that that bacteria isolated from explanted mesh specimens using culture-independent methods originate from focal bacterial communities on the mesh fiber surface. In addition, the macrophage-predominant inflammatory infiltrate seen on classical histology appears to correlate with mesh-adjacent macrophages harboring intracellular bacteria. This proposes a novel mechanism for the development and maintenance of chronic pain after transvaginal mesh placement; bacteria inoculated onto the mesh at the time of implantation may survive at the mesh interface, interacting with the host immune system to promote a low-level, chronic inflammation manifesting as chronic pain. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e147 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Victoria Scott More articles by this author A. Lenore Ackerman More articles by this author Guo Liu More articles by this author Wenyuan Shi More articles by this author Shlomo Raz More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...