When pelvic floor exercise etc. do not work: Mesh implants as therapy for a prolapsed bladder

How frequently do women in Germany suffer from a prolapsed bladder?

Approximately 40 percent of women who have had a child suffer from a bladder prolapse. The prolapse can be in the anterior vaginal wall with the bladder, the uterus, or the posterior vaginal wall with the rectum. Many of those affected have only minor symptoms. However, every ninth woman does require an operation at some time to alleviate the prolapse. 

What symptoms do affected women have to contend with? How severe are the symptoms?

Many of those affected complain of a dropping feeling, whereby the vagina or the uterus drops so far that it is visible in the vaginal opening. Frequent symptoms also include bladder dysfunction with incontinence (‘weak bladder’), or difficulties emptying the bladder. Some women are only slightly affected by this, whilst other patients complain of an enormous loss of quality of life. 

There are various options in the treatment of a prolapsed bladder. Which patients can specifically benefit from mesh implants?

Depending on the form of the prolapse and the degree of impairment, doctors initially try to avoid operating, for example by means of pelvic floor exercise or the use of pessaries, thus medical aids, which are inserted into the vagina. However, if the symptoms continue, in many cases an operation does make sense, in order to correctly reposition the vagina, bladder and the rectum. As far as possible, the patient's own connective tissue is used for stabilisation. In very pronounced cases, or following a subsequent prolapse after an operation, then a light well-tolerated plastic mesh can be used.

For prolapsed bladders which require an operation, you use the TiLOOP® Total 6 mesh implant. What is the difference between such modern meshes and the older ones, which were subject to frequent criticism?

The meshes used today are very light and have an optimised mesh structure. Thanks to the further development of the materials and operating techniques, unwanted side-effects and risks have been reduced.

The surface of the plastic thread used to produce the TiLOOP® mesh implant has been finished with titanium oxide, a chemical compound of titanium and oxygen. In my opinion, this means that the mesh can grow into the tissue optimally, and is not treated as a foreign object by the body.  

What is special about the TiLOOP® Total 6 implant and the surgical method used?

In the correction of a prolapsed bladder there are different options for fixing the mesh implants, and thus different surgical methods to stabilise the implant. TiLOOP® Total 6 features six ‘mesh arms’, which the surgeon attaches to the tissue. This stable fixing of the implant provides extended durability, so as to prevent the renewed prolapse of organs such as the bladder. 

Are there studies which prove the benefits of TiLOOP® Total 6?

A large scientific study is now available for the TiLOOP® Total 6 mesh implant, involving the long term observation of 289 patients who were given the implant. These patients were still under continuous observation three years after the operation. The very good stability was confirmed, and only very small number of patients suffered renewed prolapses. For the patients this meant amajor improvement in the quality of life. We are very pleased to see the study. Principally every new surgical technology and every new implant should have to demonstrate they provide advantages to the patient, and that the unwanted side-effects are as limited as possible. 

Our interview partner:

Dr. Christian Fünfgeld is chief physician for gynecology and obstetrics at the hospital in Tettnang. He also leads the interdisciplinary continence and pelvic floor centre of the clinic.