CYSTOCELE

MICHELO F
• . A cystocele (pronounced /ˈsɪstəsiːl/ SIS-tə-
seel) is a medical condition that occurs when
the tough fibrous wall between a woman's
bladder and her vagina (the pubocervical
fascia) is torn by childbirth, allowing the
bladder to herniate into the vagina.
Urethroceles often occur with cystoceles
 Presentation

• This condition may cause discomfort and

problems with emptying the bladder. The
elastic tissues of the vagina may compensate
for this tear for some time after the injury
occurs.
 Presentation

• Because the hormone estrogen helps keep the

elastic tissues around the vagina strong, a
cystocele may not occur until menopause,
when levels of oestrogen decrease.
• In some women a fallen bladder stretches the
opening into the urethra, causing urine
leakage when a woman sneezes, caughs,
laughs, or moves in any way causing pressure.
 Presentation Cont..
• There are no muscles around the vagina,
except the bulbocavernosus muscles at the
entrance to the vagina. The levator muscle
passes around the vagina and the rectum and
inserts into the levator plate, which can
elevate rectum, the vagina and the bladder
neck together
 Presentation Cont..
• A bladder that has dropped from its normal
position may cause two kinds of problems:
unwanted urine leakage and incomplete
emptying of the bladder. The pubocervical
fascia provides back support to the mid
urethra, allowing compression when
abdominal pressure is increased.
 Presentation Cont..
• This prevents urine loss with sudden increases
in pressure, as with coughs, sneezes, laughs, or
moves in any way that puts pressure on the
bladder. If this compression is lost by tissue
tears, then stress incontinence results.
• If the base of the bladder herniates, then urine
will sump down into the inside of the hernia,
and bladder emptying will be impaired.
 PREDISPOSING FACTORS
• Repeated child birth
• Muscle straining while giving birth
• Heavy lifting
• Contipation
• Hormone deficiency
• During menoupause oestrogen reduces (it
helps to keep vaginal muscles strong)
 Classification

A cystocele is mild (grade 1)

• When the bladder droops only a short way into
the vagina.
With more severe (grade 2)
• Cystocele, the bladder sinks far enough to reach
the opening of the vagina.
The most advanced (grade 3)
• Cystocele occurs when the bladder bulges out
through the opening of the vagina.
 Classification
• A doctor may be able to diagnose a grade 2 or
3 cystocele from a description of symptoms
and from physical examination of the vagina
because the fallen part of the bladder will be
visible.
 Diagnosis

• In more complex instances, additional testing

will be requested. A "voiding
cystourethrogram" (sis-toe-yoo-REETH-roe-
gram) is a test that involves taking x-rays of
the bladder during urination.
 Diagnosis Cont..

• This x-ray shows the shape of the bladder and

lets the doctor see any problems that might
block the normal flow of urine. Other tests
may be needed to find or rule out problems in
other parts of the urinary system.
 Treatment

• Treatment options range from no treatment

for a mild cystocele to surgery for a serious
cystocele. If a cystocele is not bothersome, the
doctor may only recommend avoiding heavy
lifting or straining that could cause the
cystocele to worsen.
 Treatment Cont..
• If symptoms are moderately bothersome, the
doctor may recommend a pessary, a device
placed in the vagina to hold the bladder in
place.
 Colporrhaphy
• Anterior culporrhaphy is done using a
speculum
• Wall of vigina os cut open to review an
opening in the supporting strucures or fascia
• Defect is closed
• Vaginal skin is repaired
SUMMARY