Can platelet-rich plasma coating improve polypropylene mesh integration? An immunohistochemical analysis in rabbits

ABSTRACT Purpose: Despite high success rates in the treatment of urinary incontinence, complications related to the use of polypropylene (PP) meshes are still a concern, especially in vaginal prolapses surgeries. The objective of this study was to assess the effect of autologous platelet-rich plasma (PRP) coating on the integration of PP meshes implanted in the vaginal submucosa of rabbits. Materials and Methods: Thirty adult New Zealand rabbits were randomly divided into two groups (n=15): PP, implanted with conventional PP meshes; and PRP, implanted with autologous PRP coated PP meshes. Animals in both groups (n=5) were euthanized at 7, 30 and 90 days postoperatively, the vaginas extracted and sent to immunohistochemical analysis for the assessment of the pro-inflammatory agent TNF-α, anti-inflammatory agents TGF-β and IL-13, collagen metabolism marker MMP-2, and angiogenesis marker CD-31. AxioVision™ image analysis was used for the calculation of the immunoreactive area and density. Statistical analysis was performed with ANOVA followed by Tukey test (p <0.05). Results: Animals in the PRP group showed significantly increased expression of the angiogenesis agent CD-31 at all experimental times when compared to the PP group (p <0.0001). However, no differences concerning the expression of the other markers were observed between the groups. Conclusion: The addition of autologous PRP gel to PP meshes can be simply and safely achieved and seems to have a positive effect on implantation site angiogenesis. Further investigations are required to ascertain PPR coated meshes clinical efficacy in prolapses and stress urinary incontinence surgeries.

Resiniferatoxin for detrusor instability refractory to anticholinergics

PURPOSE: We have evaluated the clinical and urodynamic effects of intravesical instillation of resiniferatoxin in patients with idiopathic detrusor instability refractory to anticholinergics. MATERIALS AND METHODS: There were 30 women, median age 56 years old with detrusor instability for over 6 months and a history of anticholinergic use with no response or intolerable collateral effects. A 50 nM solution of resiniferatoxin was prepared for intravesical instillation. All patients were evaluated for urinary symptoms, as well as for urodynamic assessments before and 30 days after instillation. Tolerability was analyzed during the instillation. RESULTS: A clinical improvement was observed in 30 percent of the patients with urinary urgency and in 33 percent of the patients with urge-incontinence. The mean maximum cystometric capacity before application was 303.9 ± 78.9 and after application 341 ± 84.6. No significant difference was observed (p = 0.585). The mean maximum amplitude of the contractions diminished from 47.86 ± 29.64 to 38.72 ± 30.77 (p = 0.002). CONCLUSIONS: Resiniferatoxin, in this concentration, proved to be useful in a small percentage of patients regarding clinical detrusor instability. Maximum amplitude of the involuntary contractions was significantly reduced and in 33 percent patients the involuntary contractions disappeared. Further studies with different concentrations are recommended.

Safyreã: a readjustable minimally invasive sling for female urinary stress incontinence

INTRODUCTION: SAFIRE TM is a readjustable and minimally invasive sling for the treatment of stress urinary incontinence (SUI). It is as a pubovaginal sling placed in the medial third of the urethra. The initial experience is described. MATERIALS AND METHODS: Forty-five patients (mean age = 59 years) underwent a SAFYRE TM implant to treat SUI. Physical examination and urodynamic study were performed before surgery. All patients presented symptoms of SUI and 20 percent also reported mild urgency. Approximately 60 percent of this group had a previously failed anti-incontinence procedure. Urethral hypermobility was diagnosed in 40 percent of the patients and intrinsic sphincter deficiency (ISD) in 60 percent of the cases. RESULTS: The average follow up period was 10 months. The mean operative time was 20 minutes. Dystopia repair was performed whenever necessary, during the same procedure. The average hospital stay was 24 hours. In 11 percent of the implants, bladder perforation occurred. During the postoperative period, 9 patients (20 percent) developed transient urgency symptoms. During the initial follow up period, 90 percent were found to be continent, 3 percent reported an improvement and 7 percent were unchanged. CONCLUSION: SAFYRE TM is a safe and quick procedure that allows postoperative readjustment. This technique may be an attractive alternative in the management of SUI, should the good result obtained so far prove to be long lasting.

A propósito de um novo "sling" pubovaginal absorvível: experiência inicial / A new absobable pubovaginal sling: Preliminary experience

A utilizaçao de material autólogo na criaçao de "Slings" pubovaginais tem sido a conduta de escolha no tratamento dos casos complexos de incotinência urinária aos esforços (IUE). Esta preferência em relaçao aos materiais sintético deve-se em grande parte a duas preocupações básicas, ou seja, aumento de incidência de infecçoes e a erosao da uretra. Por outro lado, a autilizaçao de slings sintéticos possibilita a realizaçao de uma grande cirurgia, com características minimamente invasivos, simplifica o procedimento e reduz o tempo operatório. Os autores descrevem a experiência inicial com a utilizaçao de um "sling" de colágeno altamente purificado, que por ser biocompatível e absorvível associa as características do material autólogo com as vantagens do material sintético. Este sling foi utilizado em 10 pacientes portadores de IUE complexa. Nao houve infecçao, rejeiçao e tampouco reaçoes alérgicas locais. O seguimento variou de 3 a 15 meses com seguimento médio de 6 meses com 80 por cento de cura. Estes resultados sugerem que o sling de colágeno pode ser útil no tratamento de IUE, caso os bons resultados obtidos até o momento se mostrem duradouros

Ultra-som transvaginal associado ao estudo urodinâmico na avaliaçåo da incontinência urinária na mulher / Transvaginal ultrasound associated to urodynamic study in the management of urinary incontinence in women

No período de janeiro a setembro de 1993 foram estudadas 15 pacientes com idade variando entre 29 a 54 anos (mediana de 43 anos), com história de incontinência urinária recidivada após tentativa de correçåo cirúrgica por diferentes métodos com o objetivo de avaliar a contribuiçåo da ultra-sonografia transvaginal associada à avaliaçåo urodinâmica no diagnóstico etiólogico. Durante a fase de enchimento vesical foram avaliados com a ultra-sonografia transvaginal a abertura do colo vesical em relaçåo às variaçöes da pressåo intravesical e quando da ocorrência de perdas urinárias. Abertura do colo vesical durante a micçåo também foi estudada. Foram diagnosticados cinco casos com instabilidade do detrusor, oito pacientes com abertura do colo vesical e perda urinária apenas quando submetidas à manobra de Valsalva e duas pacientes com o colo vesical aberto em repouso, com perda urinária contínua já na fase de enchimento vesical, correspondendo à insuficiência esfincteriana. A avaliaçåo urodinâmica associada à ultra-sonografia transvaginal constitui um método diagnóstico promissor em virtude da facilidade de aprendizado e aplicaçåo podendo vir auxiliar no diagnóstico etiólogico da incontinência urinária na mulher