Biological mesh may offer advantage in prolapse

Montreal-While long-term studies on vaginal meshes used in pelvic organ prolapse surgery are lacking, several meshes are being studied in experimental settings and are being found effective and safe at providing anatomical correction.

One such product is a biological mesh made of a cellular porcine dermis (Pelvicol, Bard Urological, Covington, GA), which appears to be an effective material for the correction of medium- and high-grade anterior compartment vaginal defects, according to a short-term study presented at the International Continence Society annual meeting. The study, by researchers from San Carlo-IDI Hospital in Rome, found that both the porcine dermis mesh and a synthetic polypropylene mesh (Prolene Soft, Ethicon, Somerville, NJ) provided satisfactory anatomical correction.

But the study's authors say the biological mesh may offer an advantage, in that it is more readily accepted by the body.

The majority of patients were postmenopausal (mean age, 62 years; range, 41 to 81 years). They were also matched for factors such as hormone replacement therapy and previous prolapse surgery. The mean parity was two, with the range being zero to five. About two-thirds of patients also underwent a concomitant hysterectomy. The two treatment groups were similar in terms of storage symptoms, urodynamic parameters, and grade of prolapse.

The patients were evaluated for a mean of 8.1 months in the polypropylene group and 8.8 months in the porcine dermis group in a prospective fashion.

Postoperatively, 58% of subjects who received the synthetic mesh were considered anatomically cured, while 68% of subjects who received the biological mesh were considered anatomically cured (not statistically significant). In both treatment arms, the 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 from baseline (57.5% vs. 13%), while patients who received the porcine dermis did not experience such a reduction in voiding symptoms (44% vs. 11.7%).

Mesh erosions occurred in three patients who received the polypropylene mesh and in one patient receiving the porcine dermis mesh.

There were no significant differences in functional parameters, such as maximum cystometric capacity, compliance, and bladder sensation.

The authors concluded that the correction rates with the porcine dermis mesh are comparable to those observed with standard surgery, but they cautioned that the data are still preliminary.

"From our initial experience, we think that the biological mesh would be more suitable for those patients with both medium- and high-grade prolapse," said principal investigator Mauro Cervigni, MD, chief of the department of urogynecology at San Carlo-IDI Hospital, and professor of urogynecology at Tor Vegata University in Rome. "The biological mesh will, over the long term, be more accepted by the body. This is the primary advantage of the dermis mesh."

James Balmforth, MD, a subspecialty trainee in urogynecology at King's College Hospital in London, emphasized that vaginal meshes used for pelvic organ prolapse surgery are still in an embryonic phase and that longer-term follow-up is necessary to determine if they will prevent prolapse recurrence.

"None of these meshes have been studied over time, so it remains to be seen what effect they will have," he said.