A histologic and immunohistochemical analysis of defective vaginal healing after continence taping procedures: a prospective case-controlled pilot study.
OBJECTIVE
The purpose of this study was to investigate vaginal rejection of polypropylene mesh after continence taping procedures.


METHODS
Of 700 women who had undergone the procedures, 17 women with sling erosion and 7 women with voiding difficulty or symptomatic vagina prolapse (control subjects) underwent histopathologic evaluation and immunohistochemistry.


RESULTS
Seven women whose condition was not responding to conservative treatment and debridements had the exposed suburethral tape excised, which revealed predominant foreign body reaction and fragmented mesh that was surrounded by histiocytes and dense fibrosis. Immunohistochemical analysis revealed that the cell density percentage of CD 20+ cells was statistically significantly greater in the persistent defective healing group than in either the single-debridement or control group ( P = .014 and P = .014, respectively). We found statistically significant differences between the persistent defective healing and single-debridement groups and between the former and control groups in the ratios of T and B cells ( P = .035 and P = .022, respectively).


CONCLUSIONS
The rate of defective vaginal healing after the procedures was 2.4%. Removal of the prosthesis and surrounding tissue at various times for the 7 women resulted in histopathologic findings that suggested a immunologic reaction. The rate of persistent defective healing of the vagina was 1%.
Wang
Alex C
AC
Division of Female Pelvic Medicine and Reconstructive Surgery, Chang Gung University Hospital, Taoyuan, Taiwan. alexwang@cgmh.org.tw
Lee
Li-Yu
LY
Lin
Cheng-Tao
CT
Chen
Jim-Ray
JR
D000328:Adult; D000368:Aged; D001707:Biopsy, Needle; D016022:Case-Control Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007150:Immunohistochemistry; D008875:Middle Aged; D010865:Pilot Projects; D011126:Polypropylenes / Q000009:adverse effects* / Q000276:immunology; D011183:Postoperative Complications / Q000175:diagnosis; D011336:Probability; D011446:Prospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D013526:Surgical Mesh / Q000009:adverse effects*; D016896:Treatment Outcome; D014550:Urinary Incontinence, Stress / Q000175:diagnosis / Q000601:surgery*; D014563:Urodynamics; D013520:Urologic Surgical Procedures / Q000009:adverse effects / Q000379:methods; D014596:Uterine Prolapse / Q000473:pathology* / Q000601:surgery*; D014945:Wound Healing / Q000502:physiology
D011126:Polypropylenes