**8. Conclusion**

Polypropylene based vaginal meshes were never designed or tested specifically for use in the pelvic floor. The complications associated with the use of these vaginal mesh implants are largely due to a poor choice of material. A basic understanding of the material properties in relation to the physiological requirements of the site of implantation is essential for those developing and evaluating materials to assist surgeons seeking to repair the weakened pelvic floor.

A major limitation here is the relative infancy of the field of urogynecology and our current inability to characterize the biomechanical features of the pelvic floor. Despite this there are now a small number of academic groups (and a very few number of commercial manufacturers) worldwide engaged in understanding the biomechanical challenges of the pelvic floor, the host response to implanted materials and how to develop biomaterials which will be designed specifically for use in the pelvic floor to be introduced on their own or with patient derived cells.

Although it is too soon for any of these approaches to have translated into clinical trials there are now alternative materials which have been rigorously evaluated *in vitro* for mechanical properties and these are starting to be evaluated in appropriate models (the sheep in Europe and monkeys in the US) which can discriminate between materials which will fail mechanically or provoke sustained inflammation and those which do not. There is now reason for optimism that better materials can and will be developed which can translate into more effective surgical support for patients without causing the unacceptably high level of severe sideeffects which patients are currently suffering with PPL mesh.
