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Pelvic Floor Prosthesis – Implant for Prolapse
A pelvic floor prosthesis is a surgically implanted device used to support or replace weakened pelvic floor tissue, commonly used to treat pelvic organ prolapse or urinary incontinence.
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A pelvic floor prosthesis is a surgically implanted device used to support or replace weakened pelvic floor tissue, commonly used to treat pelvic organ prolapse or urinary incontinence.
What Is a Pelvic Floor Prosthesis?
A pelvic floor prosthesis is a medical implant surgically placed in the pelvic region to support or replace weakened or damaged tissue. It is primarily used to treat pelvic organ prolapse and certain types of urinary incontinence. The implant is typically made from a synthetic mesh material (such as polypropylene) or from biological materials, and its purpose is to hold the pelvic organs – including the bladder, uterus, and rectum – in their correct anatomical position.
Causes and Indications
A pelvic floor prosthesis is indicated when the natural pelvic floor tissue is too weak to adequately support the pelvic organs. Common causes and indications include:
- Pelvic organ prolapse: descent of the bladder (cystocele), uterus, rectum (rectocele), or vaginal vault
- Stress urinary incontinence: involuntary leakage of urine during physical activity, coughing, or sneezing
- Vaginal childbirth: multiple or complicated deliveries can permanently damage pelvic floor structures
- Hormonal changes: reduced tissue elasticity during and after menopause
- Chronic straining or obesity: prolonged increased pressure on the pelvic floor
- Recurrent prolapse: relapse following a previous surgical repair without mesh
Diagnosis
Before implanting a pelvic floor prosthesis, a thorough gynecological or urological evaluation is performed. This typically includes:
- Clinical examination (vaginal and rectal inspection)
- Urodynamic testing to assess bladder function
- Pelvic ultrasound
- Magnetic resonance imaging (MRI) of the pelvic floor, if needed
- Prolapse staging using the POP-Q system (Pelvic Organ Prolapse Quantification)
Types of Pelvic Floor Prostheses
Synthetic Mesh
Polypropylene synthetic mesh is the most commonly used material for pelvic floor prostheses. It is durable and generally well tolerated, but may in rare cases cause complications such as mesh erosion or infection. The use of synthetic mesh is regulated in several countries and requires careful assessment of benefits versus risks.
Biological Materials
Biological prostheses are derived from animal or human tissue (e.g., porcine small intestine submucosa or human dura mater). These materials integrate into the surrounding tissue over time and are partially reabsorbed, but they typically offer lower long-term mechanical stability than synthetic mesh.
Surgical Approaches
A pelvic floor prosthesis can be implanted via several surgical routes:
- Vaginal approach: the mesh is introduced through the vagina – less invasive, but associated with a higher risk of erosion
- Abdominal approach: open or laparoscopic surgery through the abdominal wall – more precise, but more complex
- Robot-assisted surgery: a minimally invasive technique offering high precision and improved visualization
The choice of approach depends on the type and severity of the prolapse, the overall health status of the patient, and the surgical team's expertise.
Risks and Side Effects
As with any surgical procedure, implantation of a pelvic floor prosthesis carries potential risks, including:
- Mesh erosion or extrusion (the mesh cutting through surrounding tissue or mucosa)
- Infection
- Pain, particularly during sexual intercourse (dyspareunia)
- Voiding dysfunction or urinary retention
- Prolapse recurrence
- Injury to adjacent organs during surgery
Due to these risks, many professional medical societies recommend limiting the use of synthetic mesh to cases where conventional surgery has failed or in situations of recurrent prolapse.
Aftercare and Rehabilitation
Following implantation of a pelvic floor prosthesis, careful follow-up care is essential. This includes regular check-up appointments, targeted pelvic floor exercises, and physiotherapy where indicated. Physical activity should be restricted in the weeks immediately following surgery to support healing and minimize the risk of complications.
References
- Maher C et al. – Surgical management of pelvic organ prolapse in women. Cochrane Database of Systematic Reviews, 2016. DOI: 10.1002/14651858.CD004014.pub6
- European Association of Urology (EAU) – Guidelines on Urinary Incontinence and Pelvic Floor Dysfunction, 2023. Available at: uroweb.org
- U.S. Food and Drug Administration (FDA) – Urogynecologic Surgical Mesh Implants. Available at: www.fda.gov
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