What is the diagnosis and treatment for a cystocele (bladder prolapse)?

From the Guidelines

A cystocele is a condition that requires prompt evaluation and treatment to prevent worsening of symptoms and improvement of quality of life, and the initial evaluation should include a physical examination, with imaging tests such as fluoroscopy Cystocolpoproctography (CCP) considered when clinical evaluation is difficult or inadequate 1.

Diagnosis and Evaluation

The diagnosis of a cystocele typically involves a physical examination to assess the degree of prolapse and identify any associated pelvic floor dysfunction. Imaging tests, such as CCP, may be used to confirm the diagnosis, assess the severity of the prolapse, and evaluate for associated structural defects or functional abnormalities 1.

• CCP is a useful imaging test for evaluating pelvic floor dysfunction, particularly for detecting full-thickness rectal prolapse, posterior colpocele, rectocele, and peritoneocele 1.
• The sensitivity of CCP for detecting cystoceles is 96%, making it a valuable tool for diagnosing and evaluating the severity of cystoceles 1.

Treatment and Management

The treatment of a cystocele depends on the severity of the symptoms and the degree of prolapse.

• Mild cases may be managed with pelvic floor exercises (Kegel exercises) performed 3-4 times daily with 10-15 repetitions each session 1.
• For moderate to severe cases, a vaginal pessary may be fitted to provide support, or surgical repair might be necessary 1.
• The surgery, called anterior colporrhaphy, reinforces the weakened tissue between the bladder and vagina 1.

Prevention

Preventing worsening of a cystocele is crucial to improving quality of life.

• Maintaining a healthy weight, avoiding heavy lifting, treating chronic cough, and preventing constipation can help prevent worsening of a cystocele 1.
• These preventive measures can also help reduce the risk of developing a cystocele in the first place 1.

From the Research

Definition and History of Cystocele

• Cystocele, also known as anterior vaginal wall prolapse, is a condition where the bladder bulges into the vagina 2.
• The treatment of cystocele has evolved over time, with ancient reports including the use of honey, astringents, and pessaries 2.
• The development of pelvic surgery for cystocele repair has its roots in the Ebers papyrus (1550 BC) and evolved from Hippocrates (400 BC) who used pessaries with pomegranate to reduce uterine prolapse 2.

Surgical Management of Cystocele

• Anterior colporrhaphy is a surgical technique used to repair cystocele, which involves repairing the anterior vaginal wall 3.
• Tension-free vaginal tape-obturator is a minimally invasive surgical procedure that can be used in conjunction with anterior colporrhaphy to treat stress urinary incontinence and cystocele 3.
• The use of non-absorbable mesh in the repair of recurrent cystocele has been shown to increase the cure rate compared to anterior colporrhaphy alone 4.

Outcomes and Complications of Cystocele Repair

• The success rate of cystocele repair using anterior colporrhaphy and tension-free vaginal tape-obturator is high, with low intraoperative and postoperative complications 3.
• The use of non-absorbable mesh in cystocele repair is associated with a higher risk of infection, but no difference in serious complications compared to anterior colporrhaphy 4.
• Patient-reported outcomes after cystocele repair show significant improvement in symptoms and quality of life [(3,4)].