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Absorbable Synthetic Mesh

Absorbable synthetic meshes are made from polymers that undergo hydrolytic degradation in vivo — providing temporary mechanical support while native tissue infiltrates and remodels, then fully resorbing. The appeal in reconstructive urology and urogynecology is the same one that drove the search for an alternative to polypropylene: no permanent foreign body, and theoretically no long-term mesh erosion, chronic pain, or late infection.[7]

Material Types and Degradation Timeline​

Materials are classified by the duration of mechanical support — the load-bearing window during which native tissue must consolidate. This window is the dominant determinant of clinical utility.[1]

Short-term (mechanical support < 6 months)​

  • Polyglactin 910 (Vicryl) — braided; ~3 wk strength, fully absorbed ~90 d. Pronounced inflammatory response.[1][2]
  • Polyglycolic acid (PGA, Dexon) — braided; absorbed ~120 d. In sterile urine, PGA loses 64% of breaking strength by 10 days; in Proteus-infected urine, all strength is lost within 1 day — a fundamental problem for any urologic load-bearing application.[3][14]
  • Polydioxanone (PDS) — loses all strength by ~3 days in urine.[14]

Long-term (mechanical support > 6 months)​

  • Poly-4-hydroxybutyrate (P4HB, Phasix) — monofilament, macroporous; mechanical strength ~12–18 months. Favorable host response with lower myofibroblast differentiation and higher organized collagen deposition than polypropylene.[4][5]
  • Polylactide (PLA / PLLA) — >50% mechanical stability beyond 1 year; less inflammation and scar than short-term absorbables.[1]
  • PGA:TMC copolymer (GORE BIO-A) — multifilament; fully absorbed ~6–7 months. More rapid resorption and thinner repair than Phasix.[5]
  • TIGR Matrix — dual-fiber (fast ~4 mo + slow ~3 yr). Preclinical data show only partial remodeling with persistent foreign body reaction at 1 year.[6]

Partially absorbable​

Hybrid constructs (permanent PP backbone + absorbable fibers) are covered separately on the Coated / Hybrid Mesh page, including the partially-absorbable POP evidence (Farthmann, Lensen, Quemener, Steures, Cho).

MeshPolymerAbsorptionStrength window
VicrylPolyglactin 910~90 d~3 wk
DexonPGA~120 d~3–4 wk
GORE BIO-APGA:TMC~6–7 mo~6 mo
PhasixP4HB~12–18 mo~12 mo
TIGR MatrixPLA/PGA/TMC dual-fiber~3 yr (slow)Variable

Mechanism​

Temporary scaffolding: the mesh bears initial load while host tissue infiltrates, depositing collagen and forming organized connective tissue. As the polymer hydrolyzes, load transfers gradually to native tissue. The ideal absorbable mesh degrades at the rate of tissue regeneration, leaving mechanically self-sufficient tissue after complete resorption.[4][7]

Monofilament macroporous designs (Phasix) show lower bacterial colonization and a more favorable inflammatory profile than multifilament microporous designs (BIO-A).[5]

Applications in Reconstructive Urology & Urogynecology​

Transvaginal POP Repair — Evidence Does Not Support​

The 2024 Cochrane review found no difference between absorbable mesh and native tissue repair for awareness of prolapse, repeat surgery, or recurrent prolapse on examination, with insufficient evidence on other outcomes. The conclusion: "data are not supportive of absorbable meshes or biological grafts for the management of transvaginal prolapse."[9]

The partially-absorbable signal (Lensen, Farthmann) is covered on Coated / Hybrid Mesh.

P4HB Scaffold for POP — Preclinical Promise​

In a 2-year preclinical sheep model, P4HB scaffold demonstrated complete absorption with maintained tensile stiffness, significantly higher organized collagen content, lower myofibroblast differentiation, and zero vaginal exposures at 24 months vs 4/8 (50%) exposures with polypropylene. This is the most compelling current preclinical signal for an absorbable POP mesh.[4]

Bladder Reconstruction (Investigational)​

  • PLGA scaffolds seeded with autologous urothelial and smooth muscle cells regenerated baseline urodynamics by 4 months in a canine augmentation cystoplasty model — cell seeding was load-bearing for the result.[10]
  • PLGA–fibrin / PLGA–collagen composites with adipose-derived stem cells have been evaluated as bladder-wall regeneration scaffolds.[11]

Renal Surgery​

PGA mesh applied to a partial nephrectomy site in a rabbit model achieved immediate hemostasis, complete resorption by 3 months, and formation of a new fibrous capsule with no parenchymal reaction — comparable to omental fat grafts.[12]

Biodegradable Urological Stents​

Self-reinforced PLGA (80L/20G) has been evaluated for biodegradable urological stents; in vitro degradation in artificial urine correlates with clinical performance.[13]

The Urine Problem​

A consideration unique to urology: polymer degradation kinetics in urine are not the same as in interstitial tissue. Short-term absorbables (PGA, PDS, polyglactin) degrade rapidly in sterile urine — and paradoxically degradation is prolonged in acidic, infected urine in some studies — making the mechanical window unpredictable in any application with urinary exposure.[3][14] This is why short-term absorbables cannot be used as the sole load-bearing element in genitourinary reconstruction.

Advantages​

  • No permanent foreign body — theoretically eliminates long-term erosion, chronic foreign body reaction, late-onset pain.[7]
  • No mesh explantation reported in the largest absorbable-mesh series, in contrast to permanent mesh.[8]
  • Lower bacterial colonization with monofilament macroporous designs (Phasix).[5]
  • Organized collagen remodeling rather than dense scar formation — particularly with P4HB.[4]

Limitations​

  • Recurrence risk if tissue regeneration lags resorption. Short-term absorbables used alone result in failure in nearly every case.[1]
  • Unpredictable degradation in urine (above).[3][14]
  • Transvaginal POP indication unsupported by current evidence (Cochrane 2024).[9]
  • Limited long-term clinical data in urogynecologic applications — most series are 2–5 yr; >10 yr data are absent.[6]
  • No head-to-head RCTs vs permanent synthetic mesh in pelvic floor indications.

Regulatory Status​

The FDA 2019 order halting transvaginal POP mesh addresses permanent mesh; no FDA-approved transvaginal POP mesh (absorbable or permanent) is currently marketed in the US.[15] GORE BIO-A, Phasix, and TIGR Matrix are FDA-cleared for soft-tissue reinforcement, not specifically for pelvic floor.[6]

Current Use in Reconstructive Practice​

Largely supplanted by:

  • Native-tissue repair when mesh avoidance is the goal.
  • Permanent polypropylene mesh when mesh augmentation is indicated and approved (e.g., MUS, sacrocolpopexy).
  • Autologous rectus fascia when permanent biological support is preferred.

P4HB scaffolds and partially absorbable mesh constructs remain the most credible candidates for a clinical role in pelvic floor reconstruction; cell-seeded PLGA constructs remain the principal investigational route for bladder regeneration.

See also: Polypropylene Mesh, Coated / Hybrid Mesh.

References​

1. Klinge U, Schumpelick V, Klosterhalfen B. Functional Assessment and Tissue Response of Short- and Long-Term Absorbable Surgical Meshes. Biomaterials. 2001;22(11):1415-1424. doi:10.1016/s0142-9612(00)00299-4

2. Kettle C, Dowswell T, Ismail KM. Absorbable Suture Materials for Primary Repair of Episiotomy and Second Degree Tears. Cochrane Database of Systematic Reviews. 2010;(6):CD000006. doi:10.1002/14651858.CD000006.pub2

3. el-Mahrouky A, McElhaney J, Bartone FF, King L. In Vitro Comparison of the Properties of Polydioxanone, Polyglycolic Acid and Catgut Sutures in Sterile and Infected Urine. The Journal of Urology. 1987;138(4):913-915. doi:10.1016/s0022-5347(17)43415-x

4. Guler Z, Kaestner LA, Vodegel E, et al. Two-Year Preclinical Evaluation of Long-Term Absorbable Poly-4-Hydroxybutyrate Scaffold for Surgical Correction of Pelvic Organ Prolapse. International Urogynecology Journal. 2024;35(3):713-722. doi:10.1007/s00192-023-05720-0

5. Stoikes NFN, Scott JR, Badhwar A, Deeken CR, Voeller GR. Characterization of Host Response, Resorption, and Strength Properties, and Performance in the Presence of Bacteria for Fully Absorbable Biomaterials for Soft Tissue Repair. Hernia. 2017;21(5):771-782. doi:10.1007/s10029-017-1638-3

6. Miserez M, Jairam AP, Boersema GSA, et al. Resorbable Synthetic Meshes for Abdominal Wall Defects in Preclinical Setting: A Literature Review. Journal of Surgical Research. 2019;237:67-75. doi:10.1016/j.jss.2018.11.054

7. Shiroud Heidari B, Dodda JM, El-Khordagui LK, et al. Emerging Materials and Technologies for Advancing Bioresorbable Surgical Meshes. Acta Biomaterialia. 2024;184:1-21. doi:10.1016/j.actbio.2024.06.012

8. Deerenberg EB, Henriksen NA, Antoniou GA, et al. Updated Guideline for Closure of Abdominal Wall Incisions From the European and American Hernia Societies. British Journal of Surgery. 2022;109(12):1239-1250. doi:10.1093/bjs/znac302

9. 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

10. Jayo MJ, Jain D, Wagner BJ, Bertram TA. Early Cellular and Stromal Responses in Regeneration Versus Repair of a Mammalian Bladder Using Autologous Cell and Biodegradable Scaffold Technologies. The Journal of Urology. 2008;180(1):392-397. doi:10.1016/j.juro.2008.02.039

11. Salem SA, Hwei NM, Bin Saim A, et al. Polylactic-Co-Glycolic Acid Mesh Coated With Fibrin or Collagen and Biological Adhesive Substance as a Prefabricated, Degradable, Biocompatible, and Functional Scaffold for Regeneration of the Urinary Bladder Wall. Journal of Biomedical Materials Research Part A. 2013;101(8):2237-2247. doi:10.1002/jbm.a.34518

12. Mounzer AM, McAninch JW, Schmidt RA. Polyglycolic Acid Mesh in Repair of Renal Injury. Urology. 1986;28(2):127-130. doi:10.1016/0090-4295(86)90103-2

13. Välimaa T, Laaksovirta S. Degradation Behaviour of Self-Reinforced 80L/20G PLGA Devices in Vitro. Biomaterials. 2004;25(7-8):1225-1232. doi:10.1016/j.biomaterials.2003.08.072

14. Best CD, Lowe R, Shu J, Terris MK. Comparison of the Breaking Strength of Polyglactin Mesh in Urine, Serum, and Cell Culture Media. Urology. 1999;53(6):1239-1244. doi:10.1016/s0090-4295(99)00056-4

15. 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