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cystocele; vesicocele; bladder prolapse; anterior prolapse
Prolapse or herniation of the urinary bladder, usually into the vagina. A cystourethrocel involves the bladder & the urethra.
Etiology:
1) labor & delivery
2) other strain on pelvic muscles
a) strain during lifting heavy objects
b) repeated strain with bowel movements
3) estrogen depletion
Clinical manifestations:
- pelvic pressure, heaviness or a feeling that something has fallen down
Special laboratory:
- voiding cystourethrogram [3]
Complications:
-> urethra may become compressed or kinked leading to urinary overflow incontinence
Management:
1) asymptomatic urinary prolase requires no treatment
2) pessary
a) ring pessary for mild to moderate prolapse
b) Gellhorn pessary for moderate to severe prolapse
c) cube pessary
1] insufficient vaginal tone to support other pessaries
2] must be removed daily
c) treatment of choice in patients with comorbid conditions
3) bladder suspension surgery
Related
prolapse of the uterus; cervical incompetence; pudendal hernia
General
pelvic organ prolapse
References
- Stedman's Medical Dictionary 27th ed, Williams &
Wilkins, Baltimore, 1999
- Geriatrics Review Syllabus, American Geriatrics Society,
5th edition, 2002-2004
- Cystocele (Fallen Bladder)
http://kidney.niddk.nih.gov/kudiseases/pubs/cystocele/index.htm