Grafts, Meshes, and Biomaterials
Types
Biologic grafts (autologous fascia, allograft, xenograft) and synthetic meshes (polypropylene, typically type I macroporous). Synthetic mesh offers durability but risks erosion, infection, and dyspareunia. Biologic grafts have variable resorption and strength. Native tissue repair avoids mesh complications.
Indications and evidence
Mesh augmentation may reduce recurrence in anterior compartment and apical suspension (sacrocolpopexy). Transvaginal mesh for prolapse carries higher erosion risk and is reserved for selected cases. Midurethral slings are type I polypropylene and are standard for SUI. Informed consent must address mesh risks.
Traps
- Assuming all mesh is the same; type, pore size, and placement matter.
- Forgetting that transvaginal mesh has higher erosion risk than abdominal sacrocolpopexy.
- Overlooking the need for informed consent and documentation.
- Confusing graft types (autograft vs allograft vs xenograft) and their properties.
Rule of thumb
Choose the least invasive durable option matching patient goals. For apical prolapse, sacrocolpopexy with type I polypropylene is durable; for anterior vaginal wall, weigh mesh benefit against erosion risk.