[Tape erosion--local process or general reaction of the organism. The erosion rate and localization of implanted polypropylene tape in female pelvis]. / Czy erozja tasmy polipropylenowej jest reakcja miejscowa, czy ogólnoustrojowa organizmu kobiety oraz czy wystapienie tego zjawiska zalezy od miejsca implantacji tasmy w miednicy mniejszej?

OBJECTIVES: Our study was aimed to reveal whether the tape rejection is associated with increase in serum C-reactive protein level and to assess if localization of implanted polypropylene tape predisposes to its rejection. MATERIAL AND METHODS: Between January 2002 and June 2005, 780 women with SUI or pelvic organ prolapse underwent retropubic sling procedure--IVS 02 (n = 379) or transobturator suburethral tape--IVS 04 (n = 283) or posterior IVS operation (n = 118). IVS multifilament tape (Tyco Healthcare) was used in all surgeries. The same antibiotic prophylaxis and disinfected procedure were applied in all cases. Follow-up visits were performed 4-6 weeks after the operation and next were scheduled every 3 months during first year after surgery and every 6 months in the years to follow. Blood to CRP level analysis (ELISA method) was collected form all patients with mesh erosion without any concomitant inflammatory or immunologic diseases. RESULTS: Until January 2006 we have observed 28 cases of tape rejection: 5 after posterior IVS operation, 14 after IVS 02 and 9 after IVS 04. The chi-square test revealed no statistically significant differences between these groups. Ten women with mesh rejection were completely asymptomatic, two had fever and abscessi. Also, four women had pyogenic discharge from the skin or the vagina. Ten women complained of dyspareunia, vaginal bleeding and irritating voiding. We have found CRP values normal in all cases beside woman with fever and abscesi two. CONCLUSIONS: The process of mesh erosion in most cases is limited to local cellular response. The tape rejection rate is not associated with the localization of the implant in female pelvis.

Collagen deposition around polypropylene tapes implanted in the rectus fascia of female rats.

OBJECTIVE: Implantation of the mesh induces a foreign-body reaction followed by the development of connective tissue that may alter tape property. The aim of our study was to evaluate the deposition of collagen in the vicinity of monofilament tension-free vaginal tape (TVT; Ethicon Inc., Johnson & Johnson) and multifilament intravaginal slingplasty (IVS; Tyco Healthcare) polypropylene tapes implanted in female rats. METHODS: The samples of the meshes (10 mg each) were implanted in the rectus fascia of 14 Wistar female rats and removed after 42 days. Collagen was extracted with 0.5 M acetic acid and subsequently with pepsin (1 mg/ml in 0.5 M acetic acid). Collagen concentration was measured using Sircol Collagen Assay (Biocolor Ltd.) and normalised for milligrams of tape weight. For histological examination, tape samples were stained with haematoxylin and eosin or with silver for type III collagen. RESULTS: The total amount of collagen extracted did not differ significantly between TVT and IVS samples. For both tapes, extraction with acetic acid yielded a higher amount of collagen (about 70%) than extraction with pepsin. On histological examination, less densely packed bundles of collagen fibres and a slightly more intense inflammatory reaction were observed with TVT compared with IVS mesh. CONCLUSION: The total amount of collagen deposited around the polypropylene mesh implanted in female rats was similar for TVT and IVS meshes, but differences were noted in the arrangement of the collagen fibres and the intensity of the inflammatory reaction.

[Delayed positioning of multifilament tape (IVS transobturator tape) in treatment of stress urinary incontinence caused by the radiotherapy]. / Odroczone ustawienie tasmy multifilamentowej (IVS transobturator tape) w leczeniu nietrzymania moczu spowodowanego radioterapia.

Radiotherapy is used to treat advanced stages of cervical cancer. Despite optimization of the doses delivered during radiotherapy chronic urinary tract complications still occur in 1-5% of patients. We report a case of 60 years old woman, treated 10 years ago for stage III cervical carcinoma. She received both intracavitary brachytherapy and external teletherapy. Since irradiation patient suffered from the stress urinary incontinence (SUI). She was diagnosed in our department and underwent successful anti-incontinence surgery. Because of oncological history and urodynamic parameters (markedly lowered closing urethral pressure) she was assigned to intravaginal slingplasty transobturator (IVS-OT) procedure with delayed positioning of the tape. There were no intra- or postoperative complication. The check-up done four months following surgery revealed that patient have full control of micturition and markedly improved quality of life.

[Quality of life after mid-urethra polypropylene tape sling surgery (IVS, TVT) in female stress urinary incontinence]. / Ocena jakosci zycia u pacjentek po petlowej operacji wysilkowego nietrzymania moczu z zastosowaniem tasmy polipropylenowej--TVT i IVS.

INTRODUCTION: Urinary incontinence exerts a huge influence on women's quality of life in regard to hygienic problems. The great progress in female stress urinary incontinence (SUI) surgery was introduction of mid-urethra polypropylene sling procedures, which are characterized by very high efficacy, safety and minimal invasiveness. The aim of our study was to assess if functioning of lower urinary tract after minimum 1 year from TVT or IVS procedure has an impact on women's quality of life. MATERIALS AND METHODS: Analysis was done by means of King's quality of life questionnaire in Polish version from 1993. One hundred and sixty patients operated because of SUI in II-nd Department of Gynecology in Lublin in years: 1999-2001 were assessed. The mean time relapsed from surgery was 19 +/- 6 months. Eighty women were operated by TVT method (monofilament tape) and eighty by IVS method (multifilament tape. Statistical analysis was done by means of STATISTICA program, version 6. To estimate patient's quality of life according to King's questionnaire the mode value (Mo) and the frequency of mode value (fr Mo) were used in respective questions. The results in both groups were compared by Mann-Whitney test. RESULTS: Most of patients assessed the general health condition as good (fr Mo = 25; 36.9%). In TVT group Mo value indicated good health condition (fr Mo = 30; 37.5%), whereas in IVS group general health condition was estimated most commonly as satisfactory (fr Mo = 33; 41.25%). In respect to incontinence impact on life in TVT group 37.5% of patients (fr Mo = 30) reported some influence, while in IVS group 50% of women (fr Mo = 40) reported no influence (p = 0.16). Moreover, analysis revealed that in both groups the functioning of lower urinary tract does not influence their normal functioning, social contacts, physical activity, personal life, emotions or sleep. CONCLUSION: After modern incontinence surgery (TVT, IVS methods) the majority of patients reported that current bladder symptoms have no negative impact on their quality of life.

Do preoperative cytokine levels offer a prognostic factor for polypropylene mesh erosion after suburethral sling surgery for stress urinary incontinence?

When polypropylene meshes are used in reconstructive urogynecological surgery, the erosion rates vary from 3.3% to 14% and causative factors for such erosions are still unknown in many cases. Therefore, the aim of our study was to establish the role of immunologic factors in the process of polypropylene tapes erosions after suburethral sling procedures. Serum concentrations of tumor necrosis factor alpha, interleukin (IL)-2, IL-4, IL-5, IL-10, and interferon (IFN)-gamma were estimated in 123 patients suffering from stress urinary incontinence preoperatively and during 12 months follow-up using Human Th1/Th2 Cytokine Cytometric Bead Array I kit. The same immunological assessment was performed in each case of detected tape erosion. Statistical calculation was performed using UNIVARIATE, CORR, and NPAR1WAY procedures from Statistical Analysis System. The unpaired Student's t test, nonparametric Mann-Whitney U test, and Wilcoxon tests were used. Preoperative IFN-gamma concentration was significantly higher in women with subsequent polypropylene mesh erosion when compared to women with successful outcome (p < 0.05). Th1 cytokine profile may be related to the risk of the vaginal erosions following placement of polypropylene meshes. The way to lower erosion rate may involve exclusion of the patients immunologically prone to synthetic material erosion. The factor which can help to select such patients could be preoperative level of IFN-gamma.