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The clinical advantage of MRI visualization of prostheses in soft tissue prolapses is very appealing as over 1,000000 MRI-transparent synthetic meshes are implanted annually, and postoperative complications such as mesh shrinkage and migration are frequent. Here, the synthesis of a new material composed of a DTPA-Gd complex grafted onto a backbone of PMA via a covalent bond is described (DTPA-Gd-PMA). This new polymer is sprayed onto meshes and gives an MR signal for a long period without any significant release of Gd. In vitro cytocompatibility tests on fibroblasts show limited cytotoxicity. Microscopic investigations indicate that vital cells rapidly colonize the material. Finally, coated meshes implanted in rats are easily recognizable using an MR imaging system.

Global failure: Cystocele with high mobility of cranial and caudal mesh aspects on Valsalva. Results: We saw 301 patients ≥3 months after AC + mesh. 5 were excluded because of missing data, leaving 296. Mean follow-up was 1.8 years (0.3–5.6). 139 had a Perigee, 66 an Anterior Prolift, 91 an Anterior Elevate. 242 (82%) were satisfied with the outcome, 275 (93%) considered themselves cured/improved. Recurrent prolapse symptoms were reported in 65 (22%). Recurrent cystocele was noted in 128 (43%) clinically and 105 (35%) on US. Mean Ba was −1.6 (−3 to +2). Mean cystocele descent was 5.1 mm below the pubis (+ 21.8 to −44 mm). Avulsion was diagnosed in 117 patients (39.5%). Mean hiatal area on Valsalva was 33.3 cm2. Mesh failure was diagnosed in 112 (38%); global in 81, apical in 23 and anterior in 8. Cystocele recurrence was associated with hiatal area (P < 0.001) and avulsion (P = 0.017). Apical and global mesh failure were also significantly associated with these parameters, but this was not the case for anterior failure. Conclusions: We documented mesh failure after AC + mesh in 38% at a mean of 1.8 years. Most were global or apical failures, implying dislodgment of lateral and/or apical anchors or fixation, and associated with hiatal area. It is plausible that a larger hiatus subjects anchoring structures to greater loads, increasing recurrence risk. Future studies should focus on improving implant design.