Biological mesh may offer advantage in patients with cystocele

Biological mesh is likely an effective material to use for the correction of medium- and high-grade anterior compartment vaginal defects and will likely be more readily adapted by the body, according to research presented here on Friday.

The study recruited 82 patients (mean age, 62 years) who were randomized to receive a cystocele anatomical correction with either a polypropylene mesh (Prolene Soft, Ethicon, Somerville, NJ) or a biological mesh made of a cellular porcine dermis (Pelvicol, Bard Urological, Covington, GA). The majority of subjects (87%) were postmenopausal. Their mean parity was two (range, 0 to five).

Patients were evaluated for a mean of 8.1 months in the polypropylene group and 8.8 months in the porcine collagen group in a retrospective fashion. The two groups were similar in terms of storage and voiding symptoms, urodynamic parameters, and grade of prolapse. A total of 72 (87%) were available for follow-up.

Following surgery, 58% of subjects who received the synthetic mesh were considered anatomically cured, compared with 68% of subjects who received the biological mesh. In both patient arms, surgery also improved symptoms of pelvic organ prolapse, such as dragging sensation, heaviness, and the feeling of a lump.

Patients who received the polypropylene mesh experienced a statistically significant drop in voiding symptoms (57.5% vs. 13%). This decrease was not significant in patients who received the collagen matrix (44% vs. 11.7%).

While preliminary data do not provide robust evidence for using biological meshes, Mauro Cervigni, MD, the study's principal investigator, said longer-term data will likely demonstrate their efficacy. He noted that an older form of collagen matrix was used in the study.

"This is an ongoing, multicenter, randomized clinical trial," said Dr. Cervigni, chief of the department of urogynecology at San Carlo-IDI Hospital and professor of urogynecology at Tor Vegata University in Rome. "These data are preliminary, but from our initial experience, we think that the biological mesh would be more suitable for those kinds of patients. It will over the long-term be more accepted by the body."

Mesh erosions occurred in three patients who had polypropylene material and in one patient in the porcine collagen group.