Cystocele/Urethrocele

Chapter 83 Cystocele/Urethrocele



INTRODUCTION



Description: Loss of support for the anterior vagina, through rupture or attenuation of the pubovesicocervical fascia, is manifested by descent or prolapse of the urethra (urethrocele) or bladder (cystocele).

Prevalence: Ten percent to 15% of women, 30% to 40% after menopause.

Predominant Age: 40 and older, increasing with age.

Genetics: No genetic pattern.


ETIOLOGY AND PATHOGENESIS



Causes: Loss of normal tissue integrity or tissue disruption as a result of trauma (childbirth, obstetric injury, surgery).

Risk Factors: Multiparity, obesity, chronic cough, heavy lifting, intrinsic tissue weakness or atrophic changes caused by estrogen loss. Some authors include smoking as a risk factor.


CLINICAL CHARACTERISTICS



Signs and Symptoms



• Asymptomatic

• Pelvic pressure or “heaviness”

• Stress incontinence, frequency, hesitancy, incomplete voiding, or recurrent infections

• Bulging of tissue at the vaginal opening

• Descent of the anterior vaginal wall during straining

• Positive results on “Q-tip test”


DIAGNOSTIC APPROACH



Differential Diagnosis



• Urethral diverticulum

• Skene’s gland cyst, tumor, or abscess

• Anterior enterocele

• Gartner’s duct cyst

• Urgency incontinence


Associated Conditions: Stress urinary incontinence, pelvic relaxation, uterine prolapse, and other hernias.


Workup and Evaluation



Laboratory: No evaluation indicated; perform urinalysis if urinary tract infection is suspected.

Imaging: No imaging indicated.

Special Tests:

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Jun 6, 2016 | Posted by in GYNECOLOGY | Comments Off on Cystocele/Urethrocele

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