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Because its stiffness is highly directional, <jats:styled-content style=\"fixed-case\">U<\/jats:styled-content>ltraPro was implanted in two directions: <jats:styled-content style=\"fixed-case\">U<\/jats:styled-content>ltra<jats:styled-content style=\"fixed-case\">P<\/jats:styled-content>ro <jats:styled-content style=\"fixed-case\">P<\/jats:styled-content>erpendicular (less stiff) and <jats:styled-content style=\"fixed-case\">U<\/jats:styled-content>ltra<jats:styled-content style=\"fixed-case\">P<\/jats:styled-content>ro Parallel (more stiff), with the indicated direction referring to the position of the blue orientation lines relative to the longitudinal axis of the vagina. The mesh\u2013vaginal complex (<jats:styled-content style=\"fixed-case\">MVC<\/jats:styled-content>) was excised <jats:italic>in\u00a0toto<\/jats:italic> after 3\u00a0months.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main outcome measures<\/jats:title><jats:p>Active mechanical properties were quantified as the contractile force generated in the presence of 120\u00a0mmol\/l <jats:styled-content style=\"fixed-case\">KC<\/jats:styled-content>l. Passive mechanical properties (a tissue's ability to resist an applied force) were measured using a multiaxial protocol.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Vaginal contractility decreased by 80% following implantation with the Gynemesh <jats:styled-content style=\"fixed-case\">PS<\/jats:styled-content> (<jats:italic>P<\/jats:italic>\u00a0=\u00a00.001), 48% after <jats:styled-content style=\"fixed-case\">S<\/jats:styled-content>mart<jats:styled-content style=\"fixed-case\">M<\/jats:styled-content>esh (<jats:italic>P<\/jats:italic>\u00a0=\u00a00.001), 68% after <jats:styled-content style=\"fixed-case\">U<\/jats:styled-content>ltra<jats:styled-content style=\"fixed-case\">P<\/jats:styled-content>ro <jats:styled-content style=\"fixed-case\">P<\/jats:styled-content>arallel (<jats:italic>P<\/jats:italic>\u00a0=\u00a00.001) and was highly variable after <jats:styled-content style=\"fixed-case\">U<\/jats:styled-content>ltra<jats:styled-content style=\"fixed-case\">P<\/jats:styled-content>ro <jats:styled-content style=\"fixed-case\">P<\/jats:styled-content>erpendicular (<jats:italic>P<\/jats:italic>\u00a0=\u00a00.16). The tissue contribution to the passive mechanical behaviour of the <jats:styled-content style=\"fixed-case\">MVC<\/jats:styled-content> was drastically reduced for Gynemesh <jats:styled-content style=\"fixed-case\">PS<\/jats:styled-content> (<jats:italic>P<\/jats:italic>\u00a0=\u00a00.003), but not for SmartMesh (<jats:italic>P<\/jats:italic>\u00a0=\u00a00.9) or UltraPro independent of the direction of implantation (<jats:italic>P<\/jats:italic>\u00a0=\u00a00.68 and <jats:italic>P<\/jats:italic>\u00a0=\u00a00.66, respectively).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Deterioration of the mechanical properties of the vagina was highest following implantation with the stiffest mesh, Gynemesh <jats:styled-content style=\"fixed-case\">PS<\/jats:styled-content>. Such a decrease associated with implantation of a device of increased stiffness is consistent with findings from other systems employing prostheses for support.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1471-0528.12077","type":"journal-article","created":{"date-parts":[[2012,12,14]],"date-time":"2012-12-14T17:43:16Z","timestamp":1355506996000},"page":"224-232","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":139,"title":["Deterioration in biomechanical properties of the vagina following implantation of a high\u2010stiffness prolapse mesh"],"prefix":"10.1111","volume":"120","author":[{"given":"A","family":"Feola","sequence":"first","affiliation":[{"name":"Musculoskeletal Research Center Department of Bioengineering University of Pittsburgh Pittsburgh PA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S","family":"Abramowitch","sequence":"additional","affiliation":[{"name":"Musculoskeletal Research Center Department of Bioengineering University of Pittsburgh Pittsburgh PA USA"},{"name":"Department of Obstetrics, Gynecology, and Reproductive Sciences Magee\u2010Women's Research Institute Pittsburgh PA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Z","family":"Jallah","sequence":"additional","affiliation":[{"name":"Musculoskeletal Research Center Department of Bioengineering University of Pittsburgh Pittsburgh PA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S","family":"Stein","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, Gynecology, and Reproductive Sciences Magee\u2010Women's Research Institute Pittsburgh PA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"W","family":"Barone","sequence":"additional","affiliation":[{"name":"Musculoskeletal Research Center Department of Bioengineering University of Pittsburgh Pittsburgh PA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S","family":"Palcsey","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, Gynecology, and Reproductive Sciences Magee\u2010Women's Research Institute Pittsburgh PA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P","family":"Moalli","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, Gynecology, and Reproductive Sciences Magee\u2010Women's Research Institute Pittsburgh PA USA"},{"name":"Division of Urogynecology and Reconstructive Pelvic Surgery Department of Obstetrics, Gynecology, and Reproductive Sciences Magee\u2010Women's Hospital Magee\u2010Women's Research Institute University of Pittsburgh Pittsburgh PA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2012,12,14]]},"reference":[{"key":"e_1_2_5_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0029-7844(01)01472-7"},{"key":"e_1_2_5_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0029-7844(97)00058-6"},{"key":"e_1_2_5_4_1","doi-asserted-by":"publisher","DOI":"10.1067\/S0002-9378(03)00829-9"},{"key":"e_1_2_5_5_1","volume-title":"Urogynecologic Surgical Mesh: Update on the Safety and Effectiveness of Transvaginal Placement for Pelvic Organ Prolapse","author":"Food and Drug Administration (FDA)","year":"2011"},{"key":"e_1_2_5_6_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00192-011-1542-9"},{"key":"e_1_2_5_7_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1009521"},{"key":"e_1_2_5_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.2008.02023.x"},{"key":"e_1_2_5_9_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0b013e318195888d"},{"key":"e_1_2_5_10_1","volume-title":"Public Health Notification: Serious Complications Associated With Transvaginal Placement of Surgical Mesh in Repair of Pelvic Organ Prolapse and Stress Urinary Incontinence","author":"Food and Drug Administration (FDA)","year":"2008"},{"key":"e_1_2_5_11_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00192-003-1041-8"},{"key":"e_1_2_5_12_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00192-008-0781-x"},{"key":"e_1_2_5_13_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00192-007-0360-6"},{"key":"e_1_2_5_14_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00776-003-0707-x"},{"key":"e_1_2_5_15_1","doi-asserted-by":"publisher","DOI":"10.1067\/mse.2003.22"},{"key":"e_1_2_5_16_1","doi-asserted-by":"crossref","unstructured":"FeolaA PalS MoalliP MaitiS AbramowitchS editors.Varying degrees of nonlinear mechanical behavior arising from geometric differences of urogynecological meshes. 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