Histopathologic changes of porcine dermis xenografts for transvaginal suburethral slings.
OBJECTIVE
The purpose of this study was to examine the histopathologic changes of HMDI (Hexamethylene di-isocyanate) cross-linked porcine dermis grafts used for suburethral sling surgery.


METHODS
Twelve patients underwent reoperation with graft removal for urinary retention or recurrent stress urinary incontinence after transvaginal sling surgery. Tissue specimens were available for pathologic evaluation in 7 patients. Graft specimens underwent histologic preparation including hematoxylin and eosin staining. A single pathologist reviewed the slides blinded to clinical outcomes.


RESULTS
Histopathologic analyses revealed only limited collagen remodeling, and evidence of a foreign body type reaction was present in some specimens. In cases of recurrent stress incontinence, implants appeared to be completely replaced by dense fibroconnective tissue and moderate neovascularization without evidence of inflammation or graft remnants.


CONCLUSIONS
HMDI cross-linked porcine dermal collagen implants result in variable tissue reactions that may have unpredictable clinical outcomes in different patients, raising questions about the overall tolerability and efficacy of these grafts in pelvic reconstructive surgery.
Gandhi
Sanjay
S
Evanston Continence Center, Northwestern University Feinberg School of Medicine, Ill, USA. homeysan@yahoo.com
Kubba
Lena M
LM
Abramov
Yoram
Y
Botros
Sylvia M
SM
Goldberg
Roger P
RP
Victor
Thomas A
TA
Sand
Peter K
PK
D000818:Animals; D003094:Collagen / Q000648:ultrastructure; D003432:Cross-Linking Reagents / Q000494:pharmacology; D003485:Cyanates / Q000494:pharmacology; D020405:Dermis / Q000187:drug effects / Q000378:metabolism / Q000473:pathology* / Q000637:transplantation*; D005260:Female; D005549:Foreign-Body Reaction / Q000209:etiology / Q000473:pathology; D006801:Humans; D012008:Recurrence; D012086:Reoperation; D013552:Swine; D014183:Transplantation, Heterologous / Q000009:adverse effects; D014550:Urinary Incontinence, Stress / Q000601:surgery*; D016055:Urinary Retention / Q000601:surgery*
D003432:Cross-Linking Reagents; D003485:Cyanates; C013606:methylene bis(4-cyclohexylisocyanate); D003094:Collagen