Application of synthetic and natural polymers in surgical mesh for pelvic floor reconstruction

[Display omitted] •An extensive review for the design and optimization of vaginal meshes.•Effects of properties and manufacturing process on clinical efficacy were studied.•Application and challenges of synthetic and natural polymers were reviewed. Pelvic floor dysfunction (PFD) is a common gynecological problem that affects millions of women. Current treatment strategies are to restore the normal anatomical structure by non-operative procedures (such as pelvic floor myoelectric stimulation) or surgery (such as vaginal mesh implantation). Although vaginal meshes can provide effective, long-term and minimally invasive treatment for patients, certain life-altering complications may occur. Physical characteristics (such as porosity, mesh weight and mechanical properties), manufacturing process and material type are parameters that can greatly influence cell attachment, tissue proliferation and regeneration. The best clinical effectiveness of surgical meshes could be obtained by optimizing these parameters. Material type has a particularly important influence on the mechanical strength, biodegradation rate and biocompatibility of the implants. Therefore, material type selection is crucial for the development of an ideal pelvic floor repair mesh for use in pelvic floor reconstruction. The materials that are suitable for use in vaginal meshes have been broadly classified into three groups, which are synthetic polymers, natural polymers and polymer blends. This review mainly focuses on the application and biological characteristics of synthetic polymers, natural polymers and polymer blends in pelvic floor tissue engineering.