Design, mechanical and degradation requirements of biodegradable metal mesh for pelvic floor reconstruction

Pelvic organ prolapse is the herniation of surrounding tissue and organs into the vagina and/or rectum and is a result of the weakening of pelvic floor muscles, connective tissue, and fascia. It is widely accepted that 50% of women will develop prolapse, with the prevalence increasing with age, and up to 10-20% of those seek evaluation for their condition. Suture repairs of pelvic floor defects are associated with a high failure rate, and permanent meshes were introduced to reduce the recurrence rate. The meshes were successful in reducing the rate of recurrence but were also associated with a higher rate of complications (pain or erosion into surrounding organs) and as such have been banned in many countries. New materials that are able to provide tissue support without complications are urgently required. A promising new material may be a biodegradable metal, which provides support during healing and subsequently completely degrades. We summarise pelvic mesh usage, and evaluate the use of a biodegradable metal, which has advantages of biocompatibility, antibacterial properties, and mechanical properties. The remaining challenges are discussed as follows: (1) degradation rate, (2) stiffness, (3) corrosion fatigue, (4) zinc aging, and (5) MRI artifacts.