Effects of menopause, diabetes mellitus and steroid use on type I mesh-induced tissue reaction in a rat model Aysun Karabulut a, *, Sahika Pınar Akyer b , Gu ¨ lcin Abban Mete c , Barbaros Sahin d a Pamukkale University Medical School, Department of Obstetrics & Gynecology, Denizli, Turkey b Pamukkale University Medical School, Department of Anatomy, Denizli, Turkey c Pamukkale University Medical School, Department of Histology & Embryology, Denizli, Turkey d Pamukkale University Medical School, Animal Experiment Laboratory, Denizli, Turkey 1. Introduction Polypropylene monofilament mesh materials are used for various urogynecologic interventions including incontinence surgery, cystocele, rectocele, colposuspension, enterocele, and vault prolapse. Implant materials used in urogynecologic surgery are classified in 4 types according to inflammatory reaction they created, and those inducing minimal reaction and complication in living models are most desirable [1,2]. Polypropylene monofila- ment macro porous, namely Type I mesh, is the commonly preferred material in the current practice [2,3]. All mesh materials used in urogynecologic procedures result in an inflammatory process after mesh insertion. Urogynecologic surgical procedures are usually applied to patients in advanced age group who may suffer from diabetes mellitus (DM) or other chronic illnesses requiring use of steroid. Although the inflammatory processes seen with different mesh types were studied in animal models [4,5], menopausal status was disregarded in those studies. Furthermore, there was no study investigating the inflammatory process in diabetic or steroid using animal models. In animal studies related to use of mesh in the current literature, the abdominal region was usually preferred site, and meshes were implanted over rectus abdominis fascia. However, the mesh materials are indeed implanted into vagina in real subjects. The objective of this study was 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. European Journal of Obstetrics & Gynecology and Reproductive Biology 179 (2014) 27–31 A R T I C L E I N F O Article history: Received 5 December 2013 Received in revised form 17 March 2014 Accepted 22 March 2014 Keywords: Urogynecology Mesh reaction Inflammation Menopause Diabetes mellitus A B S T R A C T 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 1 cm  1 cm type I macro porous polypropylene monofilament mesh were fixed over rectus abdominis muscle on both sides of the midline, and 0.5 cm  0.5 cm 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 Æ 274 g for GI, 410 Æ 161 g for GII, 610 Æ 202 g for GIII, and 457 Æ 250 g 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. ß 2014 Elsevier Ireland Ltd. All rights reserved. * Corresponding author at: Onelya Evleri, A-4 Yenis ¸ ehir, 20125 Denizli, Turkey. Tel.: +90 258 373 3186; mobile: +90 505 713 7696. E-mail address: aysunkarabulut@yahoo.com (A. Karabulut). Contents lists available at ScienceDirect European Journal of Obstetrics & Gynecology and Reproductive Biology jou r nal h o mep ag e: w ww .elsevier .co m /loc ate/ejo g rb http://dx.doi.org/10.1016/j.ejogrb.2014.03.024 0301-2115/ß 2014 Elsevier Ireland Ltd. All rights reserved.