The challenge of stress incontinence and pelvic organ prolapse: revisiting biologic mesh materials

Curr Opin Urol. 2019 Jul;29(4):437-442. doi: 10.1097/MOU.0000000000000645.


Purpose of review: The present article reviews the history of mesh-related complications and regulations in SUI and POP repair settings, clinical outcomes associated with the use of biologic and synthetic mesh materials, and novel approaches using modified mesh materials.

Recent findings: Treatment of pelvic floor disorders, such as stress urinary incontinence (SUI) and pelvic organ prolapse (POP) commonly involves implantation of synthetic surgical mesh materials like polypropylene. Many synthetic mesh materials, however, are associated with a foreign body response upon implantation, which is characterized by fibrotic encapsulation. Complications, including erosion, infections, bleeding, and chronic pain, have led to warnings by regulatory agencies and the recall of several mesh products. To mitigate such complications, biologic mesh materials have been proposed as alternatives for SUI and POP repair.

Summary: Clinical outcomes of surgical repair of POP/SUI are similar between biologic and synthetic meshes, but biologic meshes have a lower incidence of adverse effects. Several strategies for modifying or functionalizing biological and synthetic meshes have shown promising results in preclinical studies.

Publication types

  • Review

MeSH terms

  • Biocompatible Materials / administration & dosage*
  • Biocompatible Materials / adverse effects
  • Clinical Trials as Topic
  • Humans
  • Pelvic Organ Prolapse / surgery*
  • Polypropylenes / administration & dosage
  • Polypropylenes / adverse effects
  • Suburethral Slings / adverse effects*
  • Surgical Mesh / adverse effects*
  • Urinary Incontinence, Stress / surgery*


  • Biocompatible Materials
  • Polypropylenes