Vaginal meshes used in the treatment of stress urinary incontinence (SUI) and pelvic organ prolapse (POP) have produced highly variable outcomes, causing life-changing complications in some patients while providing others with effective, minimally invasive treatments. The risk:benefit ratio when using vaginal meshes is a complex issue in which a combination of several factors, including the inherent incompatibility of the mesh material with some applications in pelvic reconstructive surgeries and the lack of appropriate regulatory approval processes at the time of the premarket clearance of these products, have contributed to the occurrence of complications caused by vaginal mesh. Surgical mesh used in hernia repair has evolved over many years, from metal implants to knitted polymer meshes that were adopted for use in the pelvic floor for treatment of POP and SUI. The evolution of the material and textile properties of the surgical mesh was guided by clinical feedback from hernia repair procedures, which were also being modified to obtain the best outcomes with use of the mesh. Current evidence shows how surgical mesh fails biomechanically when used in the pelvic floor and materials with improved performance can be developed using modern material processing and tissue engineering techniques.
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The authors thank The Urology Foundation and the Rosetrees Trust for supporting Naside Mangir. They also gratefully acknowledge the Republic of Turkey, The Ministry of National Education for funding Betül Aydemir Dikici with a PhD studentship grant.
C.R.C. has been involved in the development of bio-engineered alternatives to conventional synthetic sling materials with Symimetic Ltd. N.M., B.A.D. and S.M.N. declare no competing interests.
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Mangir, N., Aldemir Dikici, B., Chapple, C.R. et al. Landmarks in vaginal mesh development: polypropylene mesh for treatment of SUI and POP. Nat Rev Urol 16, 675–689 (2019). https://doi.org/10.1038/s41585-019-0230-2
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