From the Guidelines
A cystourethrocele is a type of pelvic organ prolapse where both the bladder and urethra herniate or bulge into the vaginal canal, typically involving the anterior compartment of the pelvic floor. This condition occurs when the supportive tissues and muscles of the pelvic floor weaken, allowing these structures to descend from their normal anatomical position 1. Women with cystourethrocele typically experience symptoms such as a feeling of pressure or fullness in the vagina, urinary issues including frequent urination or incontinence, difficulty emptying the bladder completely, and discomfort during sexual intercourse. The condition is commonly caused by factors that strain the pelvic floor, including childbirth, chronic coughing, constipation, heavy lifting, obesity, and age-related tissue weakening 1.
Diagnosis and Evaluation
The initial evaluation of patients with suspected cystourethrocele is clinical, with history and physical examination forming key elements of patient evaluation 1. Imaging may be obtained when clinical evaluation is difficult or considered inadequate by the physician, or if patients present with persistent or recurrent prolapse symptoms after attempted surgical or nonsurgical treatments. MR defecography is one of the initial imaging tests of choice for evaluation of a vaginal protrusion or bulge or clinically suspected pelvic organ prolapse, allowing for comprehensive anatomic and functional evaluation of the entire pelvic floor 1.
Treatment Options
Treatment options for cystourethrocele range from conservative approaches like pelvic floor exercises (Kegel exercises) and pessary devices to surgical repair procedures that restore the normal anatomical position of the bladder and urethra 1. The specific treatment depends on the severity of symptoms, the degree of prolapse, and the patient's overall health and preferences. Surgical repair procedures are often recommended for patients with severe symptoms or significant prolapse, while conservative approaches may be suitable for patients with mild symptoms or those who are not candidates for surgery.
Key Considerations
It is essential to note that pelvic floor abnormalities often involve multiple compartments, and a global assessment of all the pelvic compartments allows for the repair of all defects during a single procedure 1. MR defecography has moderate correlation with surgical findings for diagnosis of full-thickness rectal prolapse, internal rectal prolapse, posterior colopocele, rectocele, and peritoneocele, and is beneficial in detecting or differentiating cases of enteroceles in apical or posterior compartment prolapse 1.
Imaging Modalities
VCUG can be used as an objective measure of change in cystocele height and urethral angle after surgical repair, but its utility is limited to patients with suspected concomitant urinary dysfunction 1. MR defecography, on the other hand, provides a comprehensive evaluation of the pelvic floor and is particularly useful in detecting and differentiating cases of enteroceles and other pelvic floor abnormalities. The choice of imaging modality depends on the specific clinical scenario and the patient's symptoms and preferences.
From the Research
Definition of Cystourethrocele
- A cystourethrocele is a type of pelvic organ prolapse where the bladder and urethra bulge into the vagina, causing a herniation of these organs 2, 3.
- This condition occurs due to weaknesses in the levator sling and pubocervical fasciae, resulting in central defects and sliding herniation of the bladder and urethra 3.
Causes and Symptoms
- Cystourethrocele can be caused by childbearing, aging, and other factors that weaken the pelvic muscles, such as stretch injury of the pudendal nerve 4.
- Symptoms may include stress urinary incontinence, hesitancy, and other urinary function issues, which can be affected by the degree of prolapse 5.
Treatment Options
- Surgical approaches, such as anterior colporrhaphy and needle suspension, can be used to repair cystourethrocele and correct uterovaginal prolapse 2, 3.
- Minimally invasive techniques, such as extraperitoneal ligamentopexy, have also been used to treat uterine prolapse and cystocele 6.
- The choice of treatment depends on the severity of the prolapse, the presence of urinary incontinence, and other individual factors 4.