Bioengineered polymeric mesh with imaging contrast for enhanced urogynaecological applications

Pelvic floor disorders affect up to 50 % of women, with prevalence increasing significantly in those over 65. While transvaginal mesh (TVM) implantation remains a common treatment, its use has been associated with complications, including inflammation, infection, and poor integration, prompting the need for safer alternatives. This study introduces a novel composite mesh designed to enhance clinical outcomes by significantly improving the mechanical properties of the TVM, its biocompatibility, and enabling its visibility. The mesh consists of polymethylmethacrylate and thermoplastic polyurethane, with embedded iodine-doped carbon nanoparticles for contrast-enhanced computed tomography (CT) imaging and coated with a phosphorylcholine-based polymer to reduce protein adsorption and hence support tissue regeneration. The composite mesh showed a tensile modulus of approximately 2.7 MPa, closely matching vaginal tissue, and reduced non-specific protein adsorption by ~78 %. In vitro analysis confirmed high biocompatibility and minimal protein adsorption. Conducted in vivo mouse studies showed no adverse overall health effects or systemic inflammation based on spleen weight; however, elevations in some cytokine levels in the iodinated mesh group indicate a potential area for optimisation of mesh properties. Fecal microbiome diversity was stable in both sham and iodinated groups. Further, the mesh mimics native tissue mechanics and enables clear CT visibility for at least 14 days post-implantation, allowing non-invasive monitoring. This novel TVM presents a multifunctional platform able to address key limitations of conventional TVMs by improving CT imaging, minimising inflammation, and supporting integration, offering a promising solution for safer and more effective pelvic floor repair.