Effects of menopause, diabetes mellitus and steroid use on type I mesh-induced tissue reaction in a rat model.

OBJECTIVE

To evaluate the effects of menopause, use of steroids, diabetes mellitus, and site of implantation on the tissue response to type I polypropylene mesh used in pelvic reconstructive surgery.

STUDY DESIGN

Forty mature female albino rats were used in the study. Inflammatory reaction and mesh-tissue detachment strength were studied in 4 different animal models; control (GI), menopause (GII), steroid+menopause (GIII), and diabetes mellitus+menopause (GIV) groups. Two pieces of 1cm×1cm type I macro porous polypropylene monofilament mesh were fixed over rectus abdominis muscle on both sides of the midline, and 0.5cm×0.5cm in size was placed into paravaginal area. Nine weeks later, implanted sling materials in the vaginal region and the right abdominal side were harvested with surrounding tissue for histopathologic examination, whereas the left sided meshes were used for the mechanical testing of detachment strength.

RESULTS

The mean detachment strengths in groups were, 595±274g for GI, 410±161g for GII, 610±202g for GIII, and 457±250g for GIV (p>0.008). Inflammatory process was more intense in menopause and DM+menopause groups for both abdominal and vaginal tissues (p<0.008). There was no difference between control and steroid+menopause groups, and DM+menopause and menopause groups (p>0.008). Comparison of tissue reaction caused by meshes in abdominal and vaginal area showed more intense granulocyte infiltration in abdominal region whereas more prominent inflammation and necrosis in the vaginal site (p<0.05).

CONCLUSION

The abdominal and vaginal region show differences in tissue reaction to type I mesh, and menopause was the most determining factor on the intensity of mesh induced inflammatory response.