Abstract
Introduction and hypothesis
Since the discontinuation of manufacture and distribution of surgical mesh for transvaginal prolapse repair, the use of biologic grafts for transvaginal apical suspension has gained renewed attention. However, there is no FDA-approved device and minimal published data describing such an approach. The objective of this video is to describe a technique and to present limited short-term outcomes utilizing a porcine urinary basement membrane (UBM) graft to perform an augmented bilateral sacrospinous ligament suspension (SSLS).
Methods
We present a step-by-step overview of our technique to perform an augmented SSLS with off-label utilization of a 7- × 10-cm porcine UBM graft. We demonstrate graft sha** and application during transvaginal repair along with data describing perioperative outcomes associated with a series of 25 cases performed at our institution using the technique described.
Results
No perioperative complications related to the graft were observed in our cohort. The most common postoperative concern was buttock pain, which spontaneously resolved within 6 months. Two individuals (8%) developed recurrent prolapse within 1 year of surgery.
Conclusions
The UBM-augmented apical suspension allows for reinforced transvaginal prolapse repair without the use of permanent mesh material. We have observed good clinical success in our application of this technique, but dedicated research assessing long-term outcomes compared with a native tissue repair is needed.
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References
US Food and Drug Administration. FDA takes action to protect women’s health, orders manufacturers of surgical mesh intended for transvaginal repair of pelvic organ prolapse to stop selling all devices. 2017. https://www.fda.gov/news-events/press-announcements/fda-takes-action-protect-womens-health-orders-manufacturers-surgical-mesh-intended-transvaginal. Accessed 27 Jan 2021
Ng-Stollmann N, Funfgeld C, Gabriel B, Niesel A. The international discussion and the new regulations concerning transvaginal mesh implants in pelvic organ prolapse surgery. Int Urogynecol J. 2020;31(10):1997–2002. https://doi.org/10.1007/s00192-020-04407-0.
Glazener CM, Breeman S, Elders A, et al. Mesh, graft, or standard repair for women having primary transvaginal anterior or posterior compartment prolapse surgery: two parallel-group, multicentre, randomised, controlled trials (PROSPECT). Lancet. 2017;389(10067):381–92. https://doi.org/10.1016/S0140-6736(16)31596-3.
Winkelman WD, Macharia A, Bharadwa S, Bharadwaj M, Hacker MR, Rosenblatt PL. Composite outcomes after posterior colporrhaphy with and without biologic graft augmentation. Female Pelvic Med Reconstr Surg. 2021;27(2):e414–7. https://doi.org/10.1097/SPV.00000000000009495.
Brown BN, Londono R, Tottey S, et al. Macrophage phenotype as a predictor of constructive remodeling following the implantation of biologically derived surgical mesh materials. Acta Biomater. 2012;8(3):978–87. https://doi.org/10.1016/j.actbio.2011.11.031.
Meyer M. Processing of collagen based biomaterials and the resulting materials properties. Biomed Eng Online. 2019;18(1):24. https://doi.org/10.1186/s12938-019-0647-0.
Culligan PJ, Salamon C, Priestley JL, Shariati A. Porcine dermis compared with polypropylene mesh for laparoscopic sacrocolpopexy: a randomized controlled trial. Obstet Gynecol. 2013;121(1):143–51. https://doi.org/10.1097/AOG.0b013e31827558dc.
Remlinger NT, Gilbert TW, Yoshida M, et al. Urinary bladder matrix promotes site appropriate tissue formation following right ventricle outflow tract repair. Organogenesis. 2013;9(3):149–60. https://doi.org/10.4161/org.25394.
Liang R, Knight K, Barone W, et al. Extracellular matrix regenerative graft attenuates the negative impact of polypropylene prolapse mesh on vagina in rhesus macaque. Am J Obstet Gynecol. 2017;216(2):153.e1–9. https://doi.org/10.1016/j.ajog.2016.09.073.
Liang R, Knight K, Easley D, Palcsey S, Abramowitch S, Moalli PA. Towards rebuilding vaginal support utilizing an extracellular matrix bioscaffold. Acta Biomater. 2017;57:324–33. https://doi.org/10.1016/j.actbio.2017.05.015.
Nager CW, Visco AG, Richter HE, et al. Effect of vaginal mesh hysteropexy vs vaginal hysterectomy with uterosacral ligament suspension on treatment failure in women with uterovaginal prolapse: a randomized clinical trial. JAMA. 2019;322(11):1054–65. https://doi.org/10.1001/jama.2019.12812.
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D.L.: project development, data analysis, video assembly, video editing, manuscript writing; A.W.: project development, video editing, manuscript writing; N.S.: project development, video editing, manuscript writing.
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D.L. has no significant disclosures. A.W. receives payments from Vro Care. N.S. receives royalties from UpToDate and receives independent research funding from Ethicon Inc. and Medtronic Inc. Signed disclosures are attached to this submission.
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The study was approved by Duke University IRB: Pro00108921. Written informed consent was obtained from the patient for publication of this video article and any accompanying images.
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Luchristt, D., Weidner, A.C. & Siddiqui, N.Y. Urinary basement membrane graft-augmented sacrospinous ligament suspension: a description of technique and short-term outcomes. Int Urogynecol J 33, 1347–1350 (2022). https://doi.org/10.1007/s00192-022-05159-9
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DOI: https://doi.org/10.1007/s00192-022-05159-9