title: Do biomechanical properties of anterior vaginal wall prolapse tissue predict outcome of surgical repair?
abstract: OBJECTIVE
  We determined the relevance of the biomechanical properties of freshly harvested vaginal tissue during large cystocele repair on clinical outcome at a minimum 1-year followup.
  
  
  METHODS
  With institutional review board approval we prospectively studied the biomechanical properties of full thickness vaginal wall tissue from postmenopausal women with symptomatic Baden-Walker prolapse undergoing anterior vaginal wall suspension with cystocele repair from 2002 to 2005. A standardized biomechanical protocol was applied with stress-strain curves for Young's modulus obtained by blinded investigators. Failed repair was defined as recurrence on examination or reoperation for recurrent anterior prolapse.
  
  
  RESULTS
  A total of 32 patients (median age 72 years) had a median followup of 34 months (range 12 to 62). Median Young's modulus was statistically different in tissue samples transported in immersed vs moistened media (median 3.8 vs 7.6, p = 0.008). Associations between Young's modulus and clinical variables were described. On followup 7 patients experienced failure of the repair. After controlling for tissue transport protocol no association was seen between Young's modulus and failures (HR 1.1, p = 0.34).
  
  
  CONCLUSIONS
  This study found no association between Young's modulus and clinical results at long-term followup. This finding suggests that retropubic scarring and pelvic floor muscle properties may be more important for a successful reparative outcome than the intrinsic properties of the vaginal wall.
authors.affiliation: Department of Urology, The University of Texas Southwestern Medical Center, Dallas, Texas 75390-9110, USA.
authors.forename: Alienor S
authors.initials: AS
authors.lastname: Gilchrist
authors.forename: Amit
authors.initials: A
authors.lastname: Gupta
authors.forename: Robert C
authors.initials: RC
authors.lastname: Eberhart
authors.forename: Philippe E
authors.initials: PE
authors.lastname: Zimmern
mesh_terms: D000368:Aged; D001696:Biomechanical Phenomena; D005260:Female; D005500:Follow-Up Studies; D013509:Gynecologic Surgical Procedures / Q000379:methods; D006801:Humans; D011379:Prognosis; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D013520:Urologic Surgical Procedures / Q000379:methods; D014596:Uterine Prolapse / Q000503:physiopathology* / Q000601:surgery*; D014621:Vagina / Q000503:physiopathology*