What are the management options for a cystocele (bladder prolapse)?

From the Guidelines

Cystocele management should prioritize a stepwise approach, starting with conservative measures for mild to moderate cases, and considering surgical repair for symptomatic or advanced cases, with a focus on improving quality of life and preventing progression. When considering management options for a cystocele (bladder prolapse), it is essential to evaluate the severity of symptoms and patient-specific factors. For mild to moderate cystoceles with minimal symptoms, conservative measures are recommended first, including pelvic floor muscle exercises (Kegel exercises) performed 3 sets of 10 contractions daily for at least 3 months 1.

Conservative Management

• Vaginal pessaries, such as ring or Gellhorn types, offer non-surgical support and should be fitted by a healthcare provider and removed for cleaning every 3-6 months.
• Lifestyle modifications are important adjuncts, including weight loss for overweight patients, smoking cessation, treating chronic cough, and avoiding heavy lifting.
• Estrogen therapy (vaginal estrogen cream applied nightly for 2 weeks, then 2-3 times weekly) can improve tissue quality in postmenopausal women.

Surgical Management

For symptomatic or advanced cystoceles, surgical repair may be necessary, with anterior colporrhaphy being a common procedure, which involves reinforcing the anterior vaginal wall and pubocervical fascia 1.

• Mesh augmentation is sometimes used but carries risks of erosion and pain, and its use should be carefully considered based on patient factors and the latest evidence.

Individualized Approach

The management approach should be individualized based on the patient's age, symptom severity, sexual activity, comorbidities, and preferences, with the goal of improving quality of life and preventing progression. Regular follow-up is essential to monitor for symptom changes or complications.

From the Research

Management Options for Cystocele (Bladder Prolapse)

The management options for cystocele (bladder prolapse) can be categorized into non-surgical and surgical options.

• Non-surgical options include lifestyle modifications, pelvic floor muscle training, and drugs 2.
• Surgical options aim to support the urethra or increase bladder capacity 2.

Surgical Techniques

Surgical techniques for cystocele repair include:

• Vaginal paravaginal repair, which can be facilitated by the use of currycombs to manage sutures 3.
• Pubovaginal sling, which can be performed concurrently with a formal cystocele repair to treat stress incontinence and reduce the cystocele 4.
• The use of type I polypropylene mesh for cystocele repair, although this may be associated with complications such as bladder erosion 5.

Additional Considerations

Additional considerations in the management of cystocele include:

• Pelvic floor myofascial release, which may be beneficial for women with overactive bladder symptoms 6.
• The importance of a thorough diagnostic evaluation, including medical history, physical examination, urinalysis, and assessment of quality of life 2.