Suggestions for Flask integration
Have a look at the source for my Flask-Genshi extension for hints at how to integrate fully with Flask. Of primary interest is probably the template_loader, for supporting flask.Module templates, and generate_template() for context processors and signalling. I also include some stuff from the Jinja environment; I don't know if that makes sense for Mako. If not, at least include the url_for function in the global template context. app.update_template_context(...) adds the context-locals for you, and handles context processors too.
I'd be great if Flask-Mako would emit a signal similar to flask.template_rendered (but a custom one, don't emit the Flask one), so I can support Flask-Mako in my upcoming extension for automated testing, Flask-Attest.