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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