Post-implantation alterations of polypropylene in the human.

PURPOSE: We reviewed the mechanisms by which polypropylene mesh changes after implantation in the human body. MATERIALS AND METHODS: The existing polymer and medical literature was reviewed regarding polypropylene, including its chemical characteristics, and compositional and physical properties, which undergo alteration after implantation at various human body locations. We also reviewed the changes in those physical properties that were demonstrable in explanted specimens. RESULTS: Polypropylene in mesh form is commonly considered inert and without adverse reactions after implantation in humans. The literature suggests otherwise with reports of various degrees of degradation, including depolymerization, cross-linking, oxidative degradation by free radicals, additive leaching, hydrolysis, stress cracking and mesh shrinkage along with infection, chronic inflammation and the stimulation of sclerosis. Many substances added to polypropylene for various purposes during manufacture behave as toxic substances that are released during the degradation process. The material may also absorb various substances. These alterations in the chemical structure of polypropylene are responsible for visibly demonstrable fiber changes, resulting in the loss of structural integrity through material embrittlement. The heat of manufacturing polypropylene fibers begins the degradation process, which is augmented by the post-production heat used to flatten the mesh to prevent curling and attach anchoring appendages. CONCLUSION: Based on available evidence the polypropylene used for surgical treatment of various structural defects is not inert after implantation in the human body. The quest for the perfect mesh must continue.

Polypropylene mesh and the host response.

The use of polypropylene (PP) mesh for pelvic floor repair has been increasing dramatically over the past decade; however, tissue response in humans has not been extensively studied. This review discusses PP mesh and postimplantation host tissue response. Emphasis is placed on studies investigating the relationship between individual mesh properties and specific responses. There is an immediate inflammatory response after PP mesh implantation that lays the framework for tissue ingrowth and subsequent mesh integration. This response varies based on physical properties of individual mesh, such as pore size, weight, coatings, bacterial colonization, and biofilm production.

Quality of life and surgical satisfaction after vaginal reconstructive vs obliterative surgery for the treatment of advanced pelvic organ prolapse.

OBJECTIVE: We sought to compare quality of life and patient satisfaction after obliterative vs reconstructive surgery. STUDY DESIGN: A retrospective cohort study of women who met the following inclusion criteria: age 65 years or older, leading edge of prolapse 4 cm or greater beyond the hymen, and vaginal reconstructive or obliterative surgery. Preoperative responses to the Urogenital Distress Inventory (UDI-6) and Incontinence Impact Questionnaire (IIQ-7) were collected retrospectively. We then mailed the same questionnaires, and the Surgical Satisfaction Questionnaire (SSQ-8), to these subjects postoperatively. RESULTS: Mode of surgery was evenly split (n = 45 per group) between the 90 patients meeting the inclusion criteria. Improvements from the preoperative to postoperative Incontinence Impact Questionnaire and Urogenital Distress Inventory were comparable as were postoperative Surgical Satisfaction Questionnaire scores. CONCLUSION: Improvements in condition-specific quality of life and postoperative patient satisfaction measures are comparable in women with prolapse who undergo either reconstructive or obliterative surgery.