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Polypropylene Mesh

Polypropylene mesh is the most widely used synthetic material for midurethral slings and pelvic organ prolapse repair. It is a medical-grade thermoplastic polymer — permanent, non-absorbable, and engineered to allow tissue ingrowth through a macroporous structure.[1][2][3]

Design & Classification​

Type 1 monofilament macroporous polypropylene is the reference standard:[4]

  • Pore size >75 μm — large enough for macrophage and fibroblast passage, reducing infection risk and permitting native tissue incorporation
  • Monofilament construction — single-strand fibers (vs multifilament or braided) reduce bacterial harboring
  • Weight range: 19–44 g/m² — lower-weight ("lightweight") meshes (≤35 g/m²) are increasingly preferred for their lower stiffness and lower contraction rates
  • Available as woven or knitted — knitted structures are more conformable

Mesh Classification (Amid Classification)​

TypeStructureExampleRecommended in GU
IMacroporous, monofilamentPolypropylene (Prolene, Advantage)Yes — standard
IIMicroporousePTFE (Gore-Tex)No — obsolete for POP/SUI
IIIMacro + micro, multifilamentPolyester (Mersilene)Not standard
IVSubmicronicSilasticNo

Use Cases in Reconstructive Urology​

Midurethral Slings (the dominant indication)​

  • Retropubic mid-urethral sling (TVT) — the most-evidence-based surgical treatment for female SUI
  • Transobturator mid-urethral sling (TOT/TVT-O) — alternative route, lower bladder-injury risk but slightly different complication profile
  • Single-incision slings (mini-slings) — shortened devices; contemporary evidence supports non-inferiority

Pelvic Organ Prolapse Repair​

  • Abdominal sacrocolpopexy — polypropylene mesh is the standard for apical support; this is the one POP indication where mesh remains uncontroversial
  • Transvaginal mesh for POP — largely withdrawn from the US market (2019 FDA order) and substantially restricted elsewhere following high rates of mesh exposure, pain, and dyspareunia

Other Reconstructive Uses​

  • Abdominal wall reconstruction adjacent to urologic reconstruction (e.g., after radical cystectomy with ileal conduit)
  • Rectopexy mesh (adjacent to but distinct from urogynecologic use)

Controversy & Regulatory History​

Polypropylene mesh has been the most debated biomaterial in contemporary reconstructive practice:

  • 2008–2011 FDA safety communications flagged complications from transvaginal mesh for POP (not slings)
  • 2019 FDA Order to Cease the sale of transvaginal mesh for POP
  • Mid-urethral slings remain endorsed by major societies (AUA/SUFU, IUGA, ACOG) for SUI
  • Ongoing litigation and patient-advocacy attention continues to shape the landscape

Complications​

  • Mesh exposure (vaginal, urethral, or bladder) — retreatment rates 1–3% for slings, higher for transvaginal POP mesh
  • Pain syndromes — chronic pelvic pain, dyspareunia
  • Infection
  • Contraction and erosion — erosion into urethra or bladder requires complex revision
  • Voiding dysfunction — sling-related outlet obstruction

References​

1. American Urogynecologic Society. Midurethral Sling Supplemental Information Checklist. 2021.

2. Carter E, Johnson EE, Still M, et al. Single-Incision Sling Operations for Urinary Incontinence in Women. Cochrane Database of Systematic Reviews. 2023;10:CD008709. doi:10.1002/14651858.CD008709.pub4

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

4. 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

See also: Absorbable Mesh, Coated / Hybrid Mesh, Autologous Rectus Fascia.