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PURPOSE: Transvaginal mesh (TVM) results in a greater anatomic cure but more complications. We aimed to compare laparoscopic sacrocolpopexy (LSC) plus colporrhaphy with the small intestine submucosa (SIS) graft versus TVM for advanced pelvic organ prolapse (POP).
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Humans , Cohort Studies , Intestine, Small , Pelvic Floor , Pelvic Organ Prolapse , Polypropylenes , Prolapse , Retrospective Studies , TransplantsABSTRACT
Objective To verify the feasibility of using small intestine submucosa for graft stents.Methods A Z-type Nitinol wire stent was used as the metal stent material,and porcine small intestine submucosa was used as the biofilm material to prepare the bio-coated stent.In vitro implantation,extracorporeal pulsation and extracorporeal flexion of the stents were designed based on the requirements for the small intestine submucosa graft stent implantation during the endovascular aneurysm repair and of the mechanical properties of the graft stent during human body activity.The feasibility of using small intestine submucosa for the graft stents was evaluated according to the patency of the stent lumen after the experiment,the presence or absence of cracks in the membrane,and the presence or absence of fracture of the metal stent.Results In the in vitro experiments,all the samples were able to maintain complete tunica and luminal patency except the 8th sample that showed suture rupture.Besides,all the samples showed good rebounding and adhering properties in both in vitro implantations and extracorporeal pulsation pressure experiments,and no dangerous problems were found such as film rupture,suture loss and stent fracture.Conclusion Small intestine submucosa can meet the durability requirements of graft stents,adapt to the conditions of graft stents such as implantation,bending and blood pulsation,and can be used as the covering material of graft stents.
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Objective To evaluate efficacy and safety of porcine small intestine submucosa (SIS) for the repair of severe vaginal relaxation (stage Ⅳ) in women.Methods Biological repair meshes were fixed in 18 patients with stage Ⅵ vaginal relaxation,among which anterior walls were fixed in 12 cases,posterior walls in 5 cases,and both walls in 1 patient.Patients with POP underwent vaginal vault suspension first,then patient with SUI underwent transvaginal urinary incontinence surgery.Extravesicle fascia was transversely folded and sutured with 2-0 Mousse.The pelvic arch ligament together with vesicle fascia,SIS mesh and vaginal submucosa were sutured 3 stitches per side with 1-0 Mousse.Scar tissue at posterior vaginal wall was rhombically excised followed by transverse folding constriction of the rectovaginal fascia with 2-0 Mousse.A 1-0 Mousse was then used for colpoperineoplasty by suturing ruptured superficial anal sphincter,superficial transverse perineal muscle,and bulbocavernosus muscle.Patients were followed at 2,6,and 12 months post-operatively.Unsuccessful outcome was defined as diameter of outer 1/3 of vagina greater than 3.5 cm,or vagina prolapsed beyond hymen.Results The median follow-up was 13 months.Pelvic Organ Prolapse/Urinary Incontinence/Sexual Function Short Form Questionnaire (PISQ-12) was obtained in 13 patients and the score increased was noted (P＜0.01).Pelvic floor distress inventory-short form for scoring the quality of life (PFIQ) was collected from 18 patients and the score decreased was noted (P＜0.01).Pelvic floor impact questionnaire (PFIQ-7) was gathered in 18 patients and the score decreased was noted (P＜ 0.01).One unsuccessful case with stage Ⅱ anterior vaginal wall prolapse who underwent posterior vaginal wall fixed with patch ended with a diameter of outer 1/3 of vagina greater than 4.0 cm post-operation.Severe complications like infection,rosion,rejection or SUI were not noticed in any case.Conclusions The anatomical repair of pelvic floor is the most effective modality for vaginal rejuvenation.Adjunct SIS can enhance vaginal elasticity,reduce scar formation and recurrence,particularly.
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Objective To investigate the feasibility and efficacy of using small intestinal submucosa (SIS) as scaffold in cystoplasty augmentation for treating the neurogenic bladder.Methods We retrospectively reviewed our database of 14 patients with neurogenic bladder,including ten male and four female,between January 2011 and March 2014.The mean age in those patients was 29 years old (range 14-56 years old).The etiology of neurogenic bladder included myelomeningoceles in 8 cases and spinal cord injuries in 6 cases.The urodynamic examination showed that the mean volume of maximal bladder pressure was (150.1± 64.2) ml,mean bladder compliance was (5.2± 3.9) ml/cmH2O,maximal detrusor pressure was (44.1 ± 29.2) cmH2O.The SIS cystoplasty was performed in all patients,which the Surgisis(R) ES was used during operation.In order to enlarge the bladder,the 4-layer tissue graft was fashioned into a strap shape,rehydrated and continuously sutured to the mucous edge of opening bladder walls.Seven patients accepted the ureter reimplantation with anti-reflux technique simultaneously.Serial video-urodynamics,magnetic resonance urography (MRU) and serum analyses were used to assess the outcomes of surgery.Results All patients were undergone the operation successfully.The mean operative time was 120 min.Bowel function returned promptly after surgery.No metabolic consequences were noted.Renal function was preserved.The duration of follow-up ranged from 6 to 48 months (mean 24 months).Compared to the preoperative findings,there were significant increasing in maximum bladder capacity (P＜0.05) at the 6,12 and 24-month follow-up (150.1± 64.2) ml preoperatively,(274.9±88.7) ml at 6 months,(322.5± 144.4) ml at 12 months and (279.9± 157.9) ml at 24 months,The significant differences also exhibited in the increasing of bladder compliance (P＜0.01) at the 24-month follow-up [(5.2±3.9) ml/cmH2O preoperatively,(26.1 ±29.4) ml/cmH2O at 24 months] and decreasing of maximum detrusor pressure (P＜0.05) at the 12 and 24-month follow-up [(44.1±29.2) cmH20 preoperatively,(20.1±9.8) cmH2O at 12 months,(20.2±19.1) cmH2O at 24 months].Two patients were observed scaffold rupture one week postoperatively and healed with patent drainage.One patient developed calculi in neo-bladder at 3-months follow-up and treated with transurethral lithotripsy.Four patients were noted vesico-ureteral reflux at 12-month follow-up.The botulin toxin detrusor injection was used in 2 cases.After indwelling the catheter for 3 months,the symptoms of reflux disappeared.The oral administration of solifenacin (5mg twice per day) and tolterodine (4mg once per day) was used in other 2 patients,who also accepted the catheter indwelling at the same time.The symptom of reflux relieved in only patient.Conclusions SIS can be used effectively as a scaffold for bladder augmentation.Tissue engineering technology provides a potentially viable option for genitourinary reconstruction in patients with neurogenic bladder.
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Objective To observe the changes of osteoblasts and vascularization during osteogenesis by tissue engineering technique under the electron microscope and study the feasibility of improving vascularization of the tissue engineering bone by using the small intestine submucosa(SIS) as the scaffold. Methods The bone mesenchymal stem cells(BMSCs) were isolated by using the gradient centrifuge method.BMSCs were seeded in the SIS.The scaffold-cell constructs were cultured in vitro for two weeks.There were no cells on the SIS as control.They were implanted subcutaneously in the dorsa of the athymic mice.The implants were harvested after(in vivo) incubation for 4,8 and 12 weeks.The changes of osteoblasts and vascularization were observed under the transmission electron microscope and the scanning electron microscope. Results The BMSCs grew quite well.BMSCs differentiated on the surface of the SIS and secreted a great deal of extracellular matrices.The scaffold-cell constructs formed a lot of bone and vessels in vivo.The scaffold degraded after 12 weeks.No osteoblasts but vascularization and fibroblasts were observed as control. Conclusion SIS can be used as the scaffold for constructing tissue engineering bone as it can improve the formation of bone and vessels in vivo.
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OBJETIVO: Os procedimentos disponíveis para correção de lesões do trato urinário não são livres de complicações. Recentemente, uma nova opção tem sido investigada: o uso da submucosa de intestino delgado (SIS). Constituída de uma matriz extracelular que não apresenta tendências à rejeição, a SIS é capaz de permitir o crescimento de vasos sangüíneos, participar de processos de diferenciação celular e de ser resistente contra o desenvolvimento de processos infecciosos. O objetivo deste estudo foi avaliar a histocompatibilidade de um enxerto autólogo de submucosa de intestino delgado (SIS), quando utilizado para a ampliação da bexiga urinária. MÉTODO: Utilizaram-se oito cães adultos, pesando entre 10 e 15kg. Realizou-se laparotomia mediana e enterectomia de um segmento de jejuno de 10cm, localizado a 20cm da flexura duodeno-jejunal, seguida de anastomose terminoterminal. Desse segmento de intestino obteve-se, por dissecção, a camada submucosa. Após esvaziamento da bexiga por punção, fez-se uma incisão mediana de 3cm em sua parede, compreendendo todas as camadas. Um segmento de 3 x 2,5cm de SIS foi fixado às bordas da incisão com sutura contínua, laçada de fio absorvível 3.0 de poliglecaprone-25. No 30º dia de pós-operatório os animais foram submetidos à retirada da bexiga para estudo histopatológico. RESULTADOS: Não se observou reação inflamatória aguda. Reação inflamatória crônica esteve presente com graus discreto e moderado. A infiltração fibroblástica foi moderada. A presença de células gigantes de corpo estranho foi mínima. A epitelização foi satisfatória, não sendo completa em apenas um dos oito implantes. Ocorreu incorporação predominante de fibras colágenas tipo III, cuja média correspondeu a 70,7 por cento do colágeno total. A reabsorção da mucosa foi moderada em 7/8 dos implantes. CONCLUSÃO: Os resultados indicam que ocorre regeneração da bexiga, quando é utilizada a submucosa de intestino delgado como substrato. A submucosa de ...
BACKGROUND: Many materials, including organic and synthetic prosthesis, have been described as substitutes of the genitourinary tract. The most commonly used is the ileum, which has many advantages, as easy mobilization and regular vascular pattern. However, the ideal substitute for urinary tract has not been found yet. Ileocystoplasty is not a harmless procedure, and so, investigations are constantly being made to find new substitutes. Small intestinal submucosa (SIS) is an extracelular matrix that can be used as a reabsorbable scaffold for tissue engineering. It allows blood vessels ingrowth, epithelial and connective cells proliferation, induces growing factors production and acquires macro and microscopic characteristics similar to the native tissue. In the urinary tract, previous experimental studies have demonstrated that SIS promotes bladder regeneration. The aim of the present study was to evaluate the biocompatibility of an autologous SIS implant used for bladder augmentation. METHOD: Eight mongrel dogs, weighing between 8 and 15 kg, were prepared for surgery under general anesthesia. A 3cm full-thickness midline cystotomy was performed, followed by immediate augmentation with autologous small intestine submucosa patch graft. On the 30th post-operative day, the animals were re-operated and a fragment of the urinary bladder wall including its patch was removed for histopathogical study. RESULTS: All implants were well incorporated. Macroscopically, SIS could not be distinguished from the native bladder tissue. Mild adherences occurred on the anterior parietal peritoneum. No other macroscopic complications were found. Acute inflammatory response was absent, and chronic inflammatory cells were seen in mild degree. Foreign body reaction was not present, implying satisfactory biological acceptation of the SIS patch graft. Epithelialization was complete in 7/8 implants. Fibroblastic proliferation was moderate. The densitometry of collagen...