title: Deterioration in biomechanical properties of the vagina following implantation of a high-stiffness prolapse mesh.
abstract: OBJECTIVE
  To define the impact of prolapse mesh on the biomechanical properties of the vagina by comparing the prototype Gynemesh PS (Ethicon) to two new-generation lower stiffness meshes, SmartMesh (Coloplast) and UltraPro (Ethicon).
  
  
  METHODS
  A study employing a nonhuman primate model.
  
  
  METHODS
  University of Pittsburgh, PA, USA.
  
  
  METHODS
  Forty-five parous rhesus macaques.
  
  
  METHODS
  Meshes were implanted via sacrocolpopexy after hysterectomy and compared with sham. Because its stiffness is highly directional, UltraPro was implanted in two directions: UltraPro Perpendicular (less stiff) and UltraPro Parallel (more stiff), with the indicated direction referring to the position of the blue orientation lines relative to the longitudinal axis of the vagina. The mesh-vaginal complex (MVC) was excised in toto after 3 months.
  
  
  METHODS
  Active mechanical properties were quantified as the contractile force generated in the presence of 120 mmol/l KCl. Passive mechanical properties (a tissue's ability to resist an applied force) were measured using a multiaxial protocol.
  
  
  RESULTS
  Vaginal contractility decreased by 80% following implantation with the Gynemesh PS (P = 0.001), 48% after SmartMesh (P = 0.001), 68% after UltraPro Parallel (P = 0.001) and was highly variable after UltraPro Perpendicular (P = 0.16). The tissue contribution to the passive mechanical behaviour of the MVC was drastically reduced for Gynemesh PS (P = 0.003), but not for SmartMesh (P = 0.9) or UltraPro independent of the direction of implantation (P = 0.68 and P = 0.66, respectively).
  
  
  CONCLUSIONS
  Deterioration of the mechanical properties of the vagina was highest following implantation with the stiffest mesh, Gynemesh PS. Such a decrease associated with implantation of a device of increased stiffness is consistent with findings from other systems employing prostheses for support.
authors.affiliation: Musculoskeletal Research Center, Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: A
authors.initials: A
authors.lastname: Feola
authors.affiliation: Musculoskeletal Research Center, Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA.|Department of Obstetrics, Gynecology, and Reproductive Sciences, Magee-Women's Research Institute, Pittsburgh, PA, USA.
authors.forename: S
authors.initials: S
authors.lastname: Abramowitch
authors.affiliation: Musculoskeletal Research Center, Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Z
authors.initials: Z
authors.lastname: Jallah
authors.affiliation: Department of Obstetrics, Gynecology, and Reproductive Sciences, Magee-Women's Research Institute, Pittsburgh, PA, USA.
authors.forename: S
authors.initials: S
authors.lastname: Stein
authors.affiliation: Musculoskeletal Research Center, Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: W
authors.initials: W
authors.lastname: Barone
authors.affiliation: Department of Obstetrics, Gynecology, and Reproductive Sciences, Magee-Women's Research Institute, Pittsburgh, PA, USA.
authors.forename: S
authors.initials: S
authors.lastname: Palcsey
authors.affiliation: Department of Obstetrics, Gynecology, and Reproductive Sciences, Magee-Women's Research Institute, Pittsburgh, PA, USA.|Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics, Gynecology, and Reproductive Sciences, Magee-Women's Hospital, Magee-Women's Research Institute, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: P
authors.initials: P
authors.lastname: Moalli
mesh_terms: D000818:Animals; D001696:Biomechanical Phenomena; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000295:instrumentation*; D008253:Macaca mulatta; D011126:Polypropylenes; D013526:Surgical Mesh / Q000009:adverse effects*; D014621:Vagina / Q000503:physiopathology* / Q000601:surgery
chemical_list: D011126:Polypropylenes