title: Histopathologic changes of porcine dermis xenografts for transvaginal suburethral slings.
abstract: 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.
authors.affiliation: Evanston Continence Center, Northwestern University Feinberg School of Medicine, Ill, USA. homeysan@yahoo.com
authors.forename: Sanjay
authors.initials: S
authors.lastname: Gandhi
authors.forename: Lena M
authors.initials: LM
authors.lastname: Kubba
authors.forename: Yoram
authors.initials: Y
authors.lastname: Abramov
authors.forename: Sylvia M
authors.initials: SM
authors.lastname: Botros
authors.forename: Roger P
authors.initials: RP
authors.lastname: Goldberg
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Victor
authors.forename: Peter K
authors.initials: PK
authors.lastname: Sand
mesh_terms: 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*
chemical_list: D003432:Cross-Linking Reagents; D003485:Cyanates; C013606:methylene bis(4-cyclohexylisocyanate); D003094:Collagen