Xenograft Slings

Xenografts, or tissues derived from nonhuman donors, have been used as slings. Pelvicol™ (C.R. Bard Inc.) is a flat sheet of fibrous acellular porcine dermal collagen. It is claimed to have a composition that minimizes the risk of urethral erosions. Crosslinking with hexamethylene diisocyanate (HMDI) is believed to resist breakdown by collagenase.

DermMatrixTM (Advanced UroScience), a new biocompatible, acellular matrix, is a heterologous material made of porcine corium. It is claimed to have high omni direction tensile strength, which lessens the incidence of suture pull-through. It is non-antigenic and is adapted by the host tissue by ingrowths.

Stratasis™ (Cook Urological, Bloomington, IN) is a sub-urethral sling material constructed from porcine small intestinal submucosa. It is an acellular collagen matrix, which therefore theoretically, is nonimmunogenic. It con sists predominantly of type I collagen. It is not crosslinked, and therefore does not lead to encapsulation. It is biodegradable and resorbable. It is gradually remodeled and disappears, leaving behind normal tissue.

Fortaflex™ (Organogenesis, Canton, MA) consists of acellular collagen matrix material derived from porcine small intestine submucosa. The intestinal submucosa had a stretch capacity not seen with cadaveric fascia.

Tissue-Guard™, or Veritas® (Synovis Surgical Innovations, St. Paul, MN), is biological material derived from bovine pericardium. It is crosslinked with glutaraldehyde, which preserves its natural collagen structure. High content of glutaraldehyde crosslinking is associated with a high incidence of calcification. Their processing reduces this to less than 6 parts per million.

Clinical data supporting long-term safety and efficacy of these new allografts are not available and, thus, their use is endorsed with caution.

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