You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Incontinence - Evaluation & Therapy III1 Apr 20101772 WHAT CAN WE LEARN FROM EXPLANTED SLINGS AND MESHES IN PELVIC FLOOR SURGERY? Ruth Kirschner-Hermanns, Uwe Klinge, Bernd Klosterhalfen, Bernhard Brehmer, and Axel Heidenreich Ruth Kirschner-HermannsRuth Kirschner-Hermanns Aachen, Germany More articles by this author , Uwe KlingeUwe Klinge Aachen, Germany More articles by this author , Bernd KlosterhalfenBernd Klosterhalfen Dueren, Germany More articles by this author , Bernhard BrehmerBernhard Brehmer Aachen, Germany More articles by this author , and Axel HeidenreichAxel Heidenreich Aachen, Germany More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.1682AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES In the last 10 years implantation of slings and various textile meshes have become standard procedures in continence and female pelvic floor surgery. In contrast to hernia surgery with much longer experience knowledge of requirements for mesh material best used for incontinence and prolaps surgery is still vage. Although the intention is to implant a tensionfree sling many studies show that urethral obstruction and erosion through the urethra over time are still the most feared complications after implant of mesh material and even after TVT or TVT-O slings We analysed more than 200 explants of different materials and structures of polypropylene (PP), polyester (PET), polytetrafluorethylene (PTFE), polyvinyliedenfluoride (PVDF) used for incontinence and prolapse surgery METHODS All explanted structures were examined by extensive histological tests, such as: 1.estimation of the foreign body reaction and fibrosis 2. induction of erosions, and 3. possible induction of chronic pain by damage of peripheral nerve structures (neuroma or pseudoneuroma formation). Furthermore all explanted devices were characterized by various textile property tests, which were related to the fibrotic incorporation seen at the devices that had been explanted from humans. RESULTS Altogether, each implant indicated a typical foreign body reaction in the interface with an accumulation of epitheloid macrophages and multinucleated foreign body cells. The outer layer of the foreign body granuloma was formed by a layer of connective tissue. In small porous meshes the average thickness of the granuloma was 37μm+/-6μm vs. 21μm+/-4μm in large porous meshes. Erosions were common findings in 66+/-9% vs. 41+/-11% in the small vs. large porous group, respectively. Chronic pain and nerve damage with neuroma or pseudoneuroma formation were related to pore size and revealed 24+/-8% vs. 11+/-6% in the small vs. large porous. CONCLUSIONS Because of the marked inflammatory reaction of small pore structures, textiles with large pore should be preferred. However, the materials has to withstand considerable mechanical strains, in particular without reducing its porosity. Standard polymers like PP and PET showed considerable high damage of structural integrity, which was not found with PVDF © 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e686 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ruth Kirschner-Hermanns Aachen, Germany More articles by this author Uwe Klinge Aachen, Germany More articles by this author Bernd Klosterhalfen Dueren, Germany More articles by this author Bernhard Brehmer Aachen, Germany More articles by this author Axel Heidenreich Aachen, Germany More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...