Medium Term Outcome Of Laparoscopic Sacrocolpopexy With Xenografts Compared To Synthetic Grafts

Main Category: Urology / Nephrology
Also Included In: Transplants / Organ Donations
Article Date: 31 Jan 2010 - 0:00 PDT

email to a friend   printer friendly   opinions  

UroToday.com - Graft materials are increasingly being used to improve surgeries for pelvic floor prolapse, in an effort to reduce recurrence. There is some evidence this is indeed so, but a number of graft related complications (GRC) cause clinically relevant problems (erosion, pain, dyspareunea) and may lead to reintervention. This may be the consequence of an inappropriately balanced response of the host to the implant. One potentially causative factor for GRC is the choice of implant material. The most widely used product today is polypropylene, in an open construct with pores large enough to allow in growth of tissue by the host.

As an alternative "biologic" matrices have been proposed. These are of a xenogenic nature and the ones we tested are of porcine origin. They are acellular collagen matrices, and in earlier work from our group (Zheng F et al., Claerhout F et al.) we have shown that the host response is indeed different than the one induced by polypropylene.

Therefore these implants were used for performing a specific procedure, i.e. a level I repair of a vault prolapse. This operation by definition requires the use of a graft. In a controlled study a consecutive number of patients was implanted with xenografts. Anatomical and subjective outcomes were compared to outcomes from consecutive controls operated either prior to the xenograft cohort, or after (to allow an overall comparable follow up period), and where a polypropylene mesh was used. In our unit, patients undergoing this operation are in a standardized follow up scheme, allowing accurate documentation of individual cases by an independent assessor.

We hypothesized outcome would be comparable and that the number of GRC would be lower.

After a mean follow up of 33 months, the anatomical failure rate at the level of the vault was significantly higher (21% vs. 3%, p <0.01. There were also significantly more posterior compartment (36% vs. 19%, p <0.05) prolapses. There was a trend for an increased recurrence at any stage as well. There were also significantly more reoperations for recurrence. The use of xenografts did not reduce the number of GRC requiring reintervention for that reason. Functional outcome was equal between the two groups.

Two different xenografts were used, one was cross-linked (resistant to collagenase), the other one not (SIS). However recurrence rate was comparable for both products and could occur at any time point in the follow-up period (which is not what one would intuitively expect).

We concluded that substitution of polypropylene grafts with xenografts did not yield similar objective outcomes, neither did it reduce the number of GRC. Even if functional outcomes are comparable, it seems to us that the routine use of xenografts for this operation seems not warranted until further clinical data would prove the contrary.

This means that the ideal "biological" mesh has not been identified yet.

Limitations:
The study was a controlled, yet not randomized study.
The study involved only level I defects (vault prolapse).
Two completely implant materials were used.

Read also:
Neurourol Urodyn. 2009
Sacrocolpopexy using xenogenic acellular collagen in patients at increased risk for graft-related complications.
Claerhout F, De Ridder D, Van Beckevoort D, Coremans G, Veldman J, Lewi P, Deprest J

Written by Jan Deprest, Dirk De Ridder, Jan-Paul Roovers, Erika Werbrouck, Georges Coremans and Filip Claerhout as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations, etc., of their research by referencing the published abstract.

UroToday - the only urology website with original content written by global urology key opinion leaders actively engaged in clinical practice. To access the latest urology news releases from UroToday, go to: www.urotoday.com

Copyright © 2010 - UroToday

• Additional
• References
• Citations