Ultrasound visualization of sacrocolpopexy polyvinylidene fluoride meshes containing paramagnetic Fe particles compared with polypropylene mesh
Introduction and hypothesis
Paramagnetic Fe particles can be added during synthetic mesh production to allow visibility on magnetic resonance imaging. Our aim was to evaluate whether transperineal ultrasound (TPUS) allows visualization, measurement, and characterization of polyvinylidene fluoride (PVDF mesh) containing Fe particles compared with regular polypropylene (PP) meshes used for sacrocolpopexy.
Women up to 1.5 years after laparoscopic sacrocolpopexy who were implanted with a PP or PVDF mesh underwent clinical examination and 2D, 3D, and 4D TPUS. Acquired volumes were analyzed offline for mesh position at rest and maximal Valsalva and for mesh dimensions and characteristics, with the operator blinded to group assignment. The two groups were compared.
There were 17 women in the PP and 25 in the PVDF mesh group, without differences in baseline demographics. None had significant prolapse, recurrence, symptoms, or complications. On TPUS, mesh was visible in all patients both caudally (perineal) and cranially but was more echogenic in the PVDF mesh group. Mesh length from distal to proximal that was visible on TPUS was longer for PVDF mesh, for both anterior and posterior vaginal arms (all P < 0.05), and for mesh above the vaginal apex (P = 0.002). The inferior aspects of the mesh showed areas of double mesh layers, suggesting folding in 80% of women in both groups, without symptoms.
PVDF mesh permits clearer visualization and is seen over a longer stretch on TPUS, with longer visible mesh arms. The latter can be due to differences in operative technique, presence of microparticles, implant textile structure, or patient characteristics.
Keywords4D transperineal ultrasound Laparoscopy MRI visible mesh Mesh folding Pelvic organ prolapse Sacrocolpopexy mesh PVDF mesh
We would like to thank the patients who gave their consent to participate in this study and the MRI staff at UZ Leuven.
As stated in disclosures.
Compliance with ethical standards
Conflicts of interest
Prof. Jan Deprest was a clinical scientist for the Fonds Wetenschappelijk Vlaanderen (G069715 N). NS received a doctoral grant in the Bip-Upy project (NMP3-LA-2012-310,389; FP7) funded by the European Commission. His clinical research on sacrocolpopexy has previously been, in part, supported by an unconditional grant by Johnson & Johnson. He has previously been consulting for AMS, Johnson & Johnson, and Bard. The others have nothing to disclose.
- 6.Maher C, Feiner B, Baessler K, et al. Surgical management of pelvic organ prolapse in women. Cochrane Database Syst Rev. 2013;4:CD004014.Google Scholar
- 24.Sindhwani N, Callewaert G, Deprest T, et al. Short term post-operative morphing of sacrocolpopexy mesh measured by Magnetic Resonance Imaging. J Mech Behav Biomed Mater. 2018. https://doi.org/10.1016/j.jmbbm.2018.02.012.