Comparison of 2 single incision slings on the vagina in an ovine model

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Publisher: Elsevier B.V.
Document Type: Report
Length: 708 words

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Key words Altis; Boston Scientific; collagen; Coloplast; glycosaminoglycan; sheep; single incision slings; smooth muscle contractility; Solyx; stress urinary incontinence Background Stress urinary incontinence carries a significant healthcare burden for women worldwide. Single incision slings are minimally invasive mesh devices designed to treat stress urinary incontinence. For prolapse repair, meshes with higher porosity and lower structural stiffness have been associated with improved outcomes. Objective In this study, we compared the higher stiffness, lower porosity Altis sling with the lower stiffness, higher porosity Solyx sling in an ovine model. We hypothesized that SIS-B would have a negative impact on the host response. Study Design A total of Altis and Solyx single incision slings were implanted suburethrally into sheep according to the manufacturer's instructions on minimal tension. The mesh-urethral-vaginal complex and adjacent ungrafted vagina (no mesh control) were harvested en bloc at 3 months. Masson's trichrome and picrosirius red staining of 6 [mu]m thin sections was performed to measure interfiber distance and tissue integration. Smooth muscle contractility to a 120 mM KCl stimulus was performed in an organ bath to measure myofiber-driven contractions. Standard biochemical assays were used to quantify glycosaminoglycan, total collagen, and elastin content, and collagen subtypes. Bending stiffness was performed in response to a uniaxial force to define susceptibility to folding/buckling. Statistical analysis was performed using Mann-Whitney, Gabriel's pairwise post hoc, Wilcoxon matched-pairs, and chi-square tests. Results The animals had similar ages (3--5 years), parity (multiparous), and weights (45--72 kg). Trichrome cross sections showed that the Altis sling buckled in a "C" or "S" shape in most samples (8 of 11), whereas buckling after Solyx sling implantation was observed in only a single sample (1 of 13; P=.004). Tissue integration, as measured by the presence of collagen or smooth muscle between the mesh fibers on trichrome 4x imaging, was increased in samples implanted with the Solyx sling compared with the Altis sling (P Conclusion The structurally stiffer Altis sling had decreased tissue integration and increased propensity to buckle after implantation. Increased collagen types I and III after the implantation of this device suggests that these changes may be associated with a fibrotic response. In contrast, the Solyx sling largely maintained a flat configuration and had improved tissue integration. The deformation of the Altis sling is not an intended effect and is likely caused by its lower bending stiffness. Both meshes induced a decrease in collagen content and smooth muscle contractility similar to previous findings for prolapse meshes and consistent with stress shielding. The long-term impact of buckling warrants further investigation. Author Affiliation: (a) Department of Urology, University of Pittsburgh, Pittsburgh, PA (b) Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA (c) Department of Obstetrics, Gynecology, and Reproductive Sciences, School of Medicine, University of Pittsburgh, Pittsburgh, PA (d) Magee Women's Research Institute, University of Pittsburgh, Pittsburgh, PA (f) Department of Bioengineering, Duquesne University, Pittsburgh, PA * Corresponding author: Pamela A. Moalli, MD, PhD. Article History: Received 15 April 2020; Revised 21 June 2020; Accepted 7 July 2020 (footnote) The authors report no conflict of interest. (footnote) This study was funded by an unrestricted research grant awarded by Boston Scientific and Institutional Animal Care and Use Committee (no. 170080088). (footnote) Cite this article as: Shapiro KK, Knight KM, Liang R, et al. Comparison of 2 single incision slings on the vagina in an ovine model. Am J Obstet Gynecol 2021;224:78.e1-7. Byline: Katherine K. Shapiro, MD (a), Katrina M. Knight, PhD (b), Rui Liang, MD (c,d), Justin Cook, BS (f), Gabrielle E. King, BS (d), Steven D. Abramowitch, PhD (b,d), Pamela A. Moalli, MD, PhD [pmoalli@mail.magee.edu] (c,d,*)

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Gale Document Number: GALE|A648966085