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Bovine-Derived Grafts (Pericardium & Dermis)

Bovine-derived grafts are xenogeneic acellular bioscaffolds prepared from decellularized bovine pericardium (Peri-Guard, Veritas) or bovine dermis (Xenform). They form a distinct category from porcine xenografts, with the strongest contemporary roles in Peyronie's disease grafting and transvaginal POP repair.[1][2][3]

For the porcine-derived family, see Porcine Acellular Collagen Matrix and Porcine SIS.

Material Science & Properties​

Decellularization uses detergents (SDS, Triton X-100), enzymatic digestion, and sterilization to remove cellular antigens while preserving ECM.[1][2][3]

Commercial products:

  • Peri-Guard (Synovis / Baxter) — glutaraldehyde-fixed bovine pericardium.
  • Veritas (Synovis / Baxter) — non-crosslinked bovine pericardium.
  • Xenform (TEI Biosciences / Boston Scientific) — non-crosslinked bovine fetal dermis.

Crosslinked vs non-crosslinked is the load-bearing distinction:[2][4]

  • Glutaraldehyde fixation delays immune rejection and adds mechanical durability but compromises regenerative potential — host cells cannot infiltrate, no constructive remodeling.
  • Non-crosslinked scaffolds (Xenform, Veritas) preserve native ECM, allow host repopulation, neovascularization, and organized regeneration — but degrade more rapidly.

Decellularized bovine pericardium (DBP) maintains tensile strength after decellularization, is biocompatible with persistent cell growth, and is generally better suited for higher-stress-bearing applications than porcine pericardium.[3] In a rat model of tunica albuginea substitution, cadaveric pericardial grafts showed moderate fibrosis at 4 mo resolving to minimal fibrosis by 6 mo, with preserved erectile function comparable to dermal and vein grafts.[5]

Urologic Applications​

Peyronie's Disease — Strongest Indication​

Most extensively studied urologic application for bovine grafts.

Bovine pericardium (Peri-Guard):

StudynApproachOutcome
Otero 201743 (disabling curvature)Plaque excision + lyophilized Peri-Guard80.5% complete straightening; 12.2% residual curvature < 20°; preserved erectile function on Doppler; no rejection / infection / graft retraction.[6]
Choi / Lee 202121 (curvature > 60°)H-shaped incision + bovine pericardiumCurvature 70° → 5° (p < 0.001); 93% satisfied with results; no graft-related complications.[7]

Bovine dermis (Xenform):

  • Caraceni 2016 (n = 28, curvature ≥ 60°): plaque incision + Xenform — 75% complete straightening at 1 yr; no graft retraction or recurrence. Reduced glans sensitivity 43.8%, ED 25% — significant complications. All patients satisfied with straightening.[8]

Comparative context:

  • Rat tunica-substitution model: pericardium, dermis, vein, Gore-Tex — erectile function preserved in all; pericardial and dermal grafts had minimal fibrosis at 6 mo; Gore-Tex moderate to severe fibrosis.[5]
  • Natsos 2024 systematic review of grafts for Peyronie's: BMG had the highest straightening rates and lowest de novo ED; TachoSil best when preoperative curvature was considered; bovine pericardium had favorable outcomes but lacked large comparative trials.[9]

Urethroplasty — Limited and Preclinical​

  • Lara 2004 (canine, glutaraldehyde-fixed bovine pericardium ventral patch, n = 30 dogs): only 20% complete healing without complications; 80% urethrocutaneous fistulas, likely from infection and leakage. Authors concluded further studies were needed before clinical application.[10]

Bovine grafts have not been widely adopted for clinical urethroplasty. Porcine SIS remains the dominant off-the-shelf xenograft for urethral reconstruction; BMG remains the autologous gold standard.[11][12]

Bladder Augmentation — Mixed Preclinical​

StudyModelMaterialOutcome
Kambic 1992Canine, 50% partial cystectomyBiodegradable acetylated bovine pericardiumAdequate bladder capacity at 36 mo with smooth epithelialized inner surface; graft served as template for epithelial regeneration while progressively resorbed.[13]
Portis 2000Minipig laparoscopic augmentationBovine pericardium vs porcine SIS vs porcine ATM vs human placentalAll bovine pericardium grafts failed to incorporate; ATM and SIS remained in place with mucosal coverage and ↑ capacity.[14]
Chee 2015Case reportBovine pericardiumSuccessful repair of iatrogenic bladder defect in previously irradiated pelvis.[15]

Inconsistent overall: biodegradable preparations show promise; glutaraldehyde-fixed grafts have failed to incorporate in some models.[14][16][13]

Urogynecologic Applications​

Transvaginal POP Repair​

Bovine pericardium — Guerette 2009 RCT (n = 94, anterior colporrhaphy ± bovine pericardium):[17]

  • 1-yr anterior support: 85.7% graft vs 78.4% colporrhaphy alone (p = 0.544).
  • 2-yr success: 76.5% vs 63% (p = 0.509).
  • Low complications in both arms; no graft-attributable healing issues.
  • No statistically significant improvement over colporrhaphy alone.

Bovine dermis (Xenform) — Lipetskaia 2022 — the largest and most recent bovine-dermal POP study, FDA-mandated design:[18]

  • Prospective non-randomized multicenter: 228 Xenform vs 485 native tissue repair.
  • 36-mo success: 83.6% Xenform vs 80.5% native tissue — noninferior (90% CI −5.6% to 5.9%).
  • Graft exposure 0.9%, no erosions.
  • SAEs 5.3% vs 2.7% — also met noninferiority.

PROSPECT trial (n = 1,352, mixed biologic grafts including bovine dermis): at 2 yr, neither mesh nor biological graft improved prolapse symptoms or QoL over native-tissue repair.[19]

Cochrane 2024 (13 studies, n = 2,074; only Guerette used bovine graft specifically and PROSPECT allowed it): insufficient evidence to support routine use of grafts for transvaginal repairs.[20]

ACOG 214 (2019): biologic graft-augmented vaginal repair has similar prolapse-awareness and reoperation rates vs native tissue; most biologic grafts used in studies are no longer commercially available, complicating recommendations. Biologic grafts may be considered for sacrocolpopexy in women at increased risk of synthetic mesh complications (chronic steroid use, current smokers).[21]

Sacrocolpopexy​

Deprest 2009 mixed-xenograft series (n = 50 vs 100 polypropylene): xenografts had more apical failures (21% vs 3%); all reoperations in xenograft arm. Bovine pericardium (Veritas) used off-label at some centers; published bovine-specific sacrocolpopexy data remain sparse.[22]

Stress Urinary Incontinence​

Minimal published data on bovine grafts specifically for slings. The SUI sling literature is dominated by porcine dermis (Pelvicol) and porcine SIS. AUA/SUFU 2023 does not specifically address bovine slings; autologous fascia remains the preferred biologic sling.[23][24]

Summary​

ApplicationProductSuccessKey finding
Peyronie's (bovine pericardium)Peri-Guard80.5–93% straighteningSafe, preserved erectile function; no rejection
Peyronie's (bovine dermis)Xenform75% straighteningNo retraction; glans sensitivity loss 43.8%, ED 25%
Anterior colporrhaphy (bovine pericardium)Peri-Guard76.5–85.7% (1–2 yr)RCT — no improvement over colporrhaphy alone
Transvaginal POP (bovine dermis)Xenform83.6% at 36 moNoninferior to native tissue; exposure 0.9%, no erosion
Bladder augmentation (bovine pericardium)VariousVariableBiodegradable forms regenerate; glutaraldehyde-fixed fails to incorporate
Urethroplasty (bovine pericardium)Glutaraldehyde-fixed20% (preclinical)80% fistula in canine model; not clinically adopted

Advantages vs Porcine​

  • Mechanical strength — bovine pericardium withstands intracorporal pressure; well-suited for Peyronie's grafting.[5][7]
  • Very low erosion with Xenform (0.9%, no graft erosion reported) in transvaginal POP.[18]
  • Non-crosslinked bovine grafts (Xenform, Veritas) drive constructive remodeling similar to porcine ECM.[2]

Limitations​

  • Limited clinical evidence vs porcine SIS / porcine dermis, particularly for urethroplasty and SUI slings.
  • Glutaraldehyde fixation compromises regeneration; bladder-augmentation incorporation failures.[2][14]
  • No superiority over native tissue for POP in RCTs.[17][19]
  • Residual antigenicity with incomplete decellularization can drive foreign-body response and fibrotic encapsulation.[2]

Current Status & Future​

  • Xenform (bovine fetal dermis) — most actively studied product in urogynecology; 36-mo FDA-mandated study showed noninferiority to native tissue repair.[18]
  • Peri-Guard — favorable safety and efficacy profile for Peyronie's grafting.[6][7]
  • A 2024 review of biologic grafts for POP concluded modest evidence for anterior-wall augmentation, particularly for recurrent POP, but called for more robust trials.[25]

Novel decellularization approaches (e.g., ASB-14 detergent that removes both hydrophilic and lipophilic antigens) have shown promise in promoting full-thickness cellular repopulation and avoiding fibrotic encapsulation of bovine pericardium — potentially overcoming current glutaraldehyde-fixed limitations.[2] Modified bovine dECMs with aliphatic chain crosslinking have shown enhanced stretchability, enzymatic resistance, and support for bladder-wall regeneration in preclinical models.[4]

See also: Porcine Acellular Collagen Matrix, Porcine SIS, Decellularized ECM, Polypropylene Mesh, Autologous Rectus Fascia.

References​

1. Davis NF, McGuire BB, Callanan A, Flood HD, McGloughlin TM. Xenogenic Extracellular Matrices as Potential Biomaterials for Interposition Grafting in Urological Surgery. The Journal of Urology. 2010;184(6):2246-2253. doi:10.1016/j.juro.2010.07.038

2. Wong ML, Wong JL, Vapniarsky N, Griffiths LG. In Vivo Xenogeneic Scaffold Fate Is Determined by Residual Antigenicity and Extracellular Matrix Preservation. Biomaterials. 2016;92:1-12. doi:10.1016/j.biomaterials.2016.03.024

3. El-Husseiny HM, Mady EA, Kaneda M, et al. Comparison of Bovine- and Porcine-Derived Decellularized Biomaterials: Promising Platforms for Tissue Engineering Applications. Pharmaceutics. 2023;15(7):1906. doi:10.3390/pharmaceutics15071906

4. Sharma S, Rajani S, Hui J, et al. Development of Enzymatic-Resistant and Compliant Decellularized Extracellular Matrixes via Aliphatic Chain Modification for Bladder Tissue Engineering. ACS Applied Materials & Interfaces. 2022;14(33):37301-37315. doi:10.1021/acsami.2c06865

5. Leungwattanakij S, Bivalacqua TJ, Yang DY, Hyun JS, Hellstrom WJ. Comparison of Cadaveric Pericardial, Dermal, Vein, and Synthetic Grafts for Tunica Albuginea Substitution Using a Rat Model. BJU International. 2003;92(1):119-124. doi:10.1046/j.1464-410x.2003.04279.x

6. Otero JR, Gómez BG, Polo JM, et al. Use of a Lyophilized Bovine Pericardium Graft to Repair Tunical Defect in Patients With Peyronie's Disease: Experience in a Clinical Setting. Asian Journal of Andrology. 2017;19(3):316-320. doi:10.4103/1008-682X.171572

7. Choi JB, Lee DS. Efficacy of H-Shaped Incision With Bovine Pericardial Graft in Peyronie's Disease: A 1-Year Follow-Up Using Penile Doppler Ultrasonography. International Journal of Impotence Research. 2021;33(5):541-547. doi:10.1038/s41443-020-0312-y

8. Caraceni E, Leone L, Utizi L, Marronaro A. Use of a Non-Cross-Linked Xenograft (Xenform) in Surgical Treatment of Peyronie's Disease. Urology. 2016;95:103-107. doi:10.1016/j.urology.2016.05.040

9. Natsos A, Tatanis V, Kontogiannis S, et al. Grafts in Peyronie's Surgery Without the Use of Prostheses: A Systematic Review and Meta-Analysis. Asian Journal of Andrology. 2024;26(3):250-259. doi:10.4103/aja202358

10. Lara RC, Lucon AM, Arap S. Urethroplasty Using a Bovine Pericardium Graft: An Experimental Study Using Normal Urethras From Dogs. Brazilian Journal of Medical and Biological Research. 2004;37(3):327-331. doi:10.1590/s0100-879x2004000300006

11. Cannoletta D, Pederzoli F, Yepes C, et al. Evolution and Innovation in Urethroplasty: A Comprehensive Narrative Review of Graft Types and Surgical Techniques. International Journal of Impotence Research. 2026;38(4):269-275. doi:10.1038/s41443-025-01040-7

12. Mangera A, Patterson JM, Chapple CR. A Systematic Review of Graft Augmentation Urethroplasty Techniques for the Treatment of Anterior Urethral Strictures. European Urology. 2011;59(5):797-814. doi:10.1016/j.eururo.2011.02.010

13. Kambic H, Kay R, Chen JF, et al. Biodegradable Pericardial Implants for Bladder Augmentation: A 2.5-Year Study in Dogs. The Journal of Urology. 1992;148(2 Pt 2):539-543. doi:10.1016/s0022-5347(17)36649-1

14. Portis AJ, Elbahnasy AM, Shalhav AL, et al. Laparoscopic Augmentation Cystoplasty With Different Biodegradable Grafts in an Animal Model. The Journal of Urology. 2000;164(4):1405-1411.

15. Chee JY, Durai P, Wu FM, Tiong HY. Bladder Repair Following Iatrogenic Cystotomy in Irradiated Small Capacity Bladders. Singapore Medical Journal. 2015;56(3):e49-e52. doi:10.11622/smedj.2015052

16. Chua ME, Farhat WA, Ming JM, McCammon KA. Review of Clinical Experience on Biomaterials and Tissue Engineering of Urinary Bladder. World Journal of Urology. 2020;38(9):2081-2093. doi:10.1007/s00345-019-02833-4

17. Guerette NL, Peterson TV, Aguirre OA, et al. Anterior Repair With or Without Collagen Matrix Reinforcement: A Randomized Controlled Trial. Obstetrics and Gynecology. 2009;114(1):59-65. doi:10.1097/AOG.0b013e3181a81b41

18. Lipetskaia L, Gonzalez RR, Wu JM, et al. Thirty-Six-Month Prospective Study of Transvaginal Bovine Graft vs Native Tissue Repair for the Treatment of Pelvic Organ Prolapse. Urology. 2022;167:234-240. doi:10.1016/j.urology.2022.06.003

19. Glazener CM, Breeman S, Elders A, et al. Mesh, Graft, or Standard Repair for Women Having Primary Transvaginal Anterior or Posterior Compartment Prolapse Surgery (PROSPECT). Lancet. 2017;389(10067):381-392. doi:10.1016/S0140-6736(16)31596-3

20. Yeung E, Baessler K, Christmann-Schmid C, et al. Transvaginal Mesh or Grafts or Native Tissue Repair for Vaginal Prolapse. Cochrane Database of Systematic Reviews. 2024;3:CD012079. doi:10.1002/14651858.CD012079.pub2

21. Committee on Practice Bulletins—Gynecology and American Urogynecologic Society. Pelvic Organ Prolapse: ACOG Practice Bulletin, Number 214. Obstetrics and Gynecology. 2019;134(5):e126-e142. doi:10.1097/AOG.0000000000003519

22. Deprest J, De Ridder D, Roovers JP, et al. Medium Term Outcome of Laparoscopic Sacrocolpopexy With Xenografts Compared to Synthetic Grafts. The Journal of Urology. 2009;182(5):2362-2368. doi:10.1016/j.juro.2009.07.043

23. Khan ZA, Nambiar A, Morley R, et al. Long-Term Follow-Up of a Multicentre Randomised Controlled Trial Comparing Tension-Free Vaginal Tape, Xenograft and Autologous Fascial Slings for the Treatment of Stress Urinary Incontinence in Women. BJU International. 2015;115(6):968-977. doi:10.1111/bju.12851

24. Wu JM. Stress Incontinence in Women. The New England Journal of Medicine. 2021;384(25):2428-2436. doi:10.1056/NEJMcp1914037

25. Lorente K, Chang O. Biologic Grafts for Pelvic Organ Prolapse Repairs: What Have We Learned in the Last 20 Years? Current Opinion in Obstetrics & Gynecology. 2024;36(6):439-443. doi:10.1097/GCO.0000000000000990