DOI: https://dx.doi.org/10.18203/2394-6040.ijcmph20220051
Published: 2022-01-28

Etiology, staging, and management of cystocele

Sheema Sabahath, Abdullah Haitham Bogis, Taif Shabib Al Mutairi, Hasan Yousef Alshahabi, Hussain Ahmed Al Sayhab, Faris Hasan Basyouni, Samah Mohamed Shehab, Mohammed Khaled Al Hijji, Eilaf Ahmed Alhusaini, Alfaf Salah Aljohani

Abstract


A cystocele is usually found to protrude the urinary bladder through the vaginal wall. Various causes have been reported in the literature for the pathogenesis and development of cystocele. These can cumulatively lead to a remarkable weakness in the muscular and connective tissue layers related to the urinary bladder and anterior vaginal wall. The present study discusses the etiology, staging, and management of patients with cystocele. Evidence indicates that a defect within the pelvic-floor supporting system can significantly lead to the development of cystocele. Parity, increasing age, and obesity are the main associated risk factors for developing these events. Staging is important to decide the most suitable treatment plan, which might be conservative or surgical. Some patients do not require any management approach, being asymptomatic, and refuse the current treatment modalities. Surgery has been associated with enhanced outcomes and can be conducted via two different approaches, including anterior colporrhaphy and sacral colpopexy.

 


Keywords


Cystocele, Vaginal prolapse, Staging, Management, Causes, Etiology, Risk factors

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References


Comiter CV, Vasavada SP, Raz S. Transvaginal culdosuspension: technique and results. Urology. 1999;54(5):819-22.

Bradley CS, Zimmerman MB, Wang Q, Nygaard IE. Vaginal descent and pelvic floor symptoms in postmenopausal women: a longitudinal study. Obstetr Gynecol. 2008;111(5):1148-53.

Nygaard I, Bradley C, Brandt D. Pelvic organ prolapse in older women: prevalence and risk factors. Obstetr Gynecol. 2004;104(3):489-97.

Bradley CS, Zimmerman MB, Qi Y, Nygaard IE. Natural history of pelvic organ prolapse in postmenopausal women. Obstetri Gynecol. 2007;109(4):848-54.

Urbankova I, Grohregin K, Hanacek J. The effect of the first vaginal birth on pelvic floor anatomy and dysfunction. Int Urogynecol J. 2019;30(10):1689-96.

Nygaard I, Barber MD, Burgio KL. Prevalence of symptomatic pelvic floor disorders in US women. JAMA. 2008;300(11):1311-6.

Sze EH, Sherard GB, 3rd, Dolezal JM. Pregnancy, labor, delivery, and pelvic organ prolapse. Obstetr gynecol. 2002;100(5 Pt 1):981-6.

Mant J, Painter R, Vessey M. Epidemiology of genital prolapse: observations from the Oxford Family Planning Association Study. Bri J Obstetr Gynaecol. 1997;104(5):579-85.

Swift S, Woodman P, O'Boyle A. Pelvic Organ Support Study (POSST): the distribution, clinical definition, and epidemiologic condition of pelvic organ support defects. Am J Obstetr Gynecol. 2005;192(3):795-806.

Hendrix SL, Clark A, Nygaard I, Aragaki A, Barnabei V, McTiernan A. Pelvic organ prolapse in the Women's Health Initiative: gravity and gravidity. Am J Obstetr Gynecol. 2002;186(6):1160-6.

Tinelli A, Malvasi A, Rahimi S. Age-related pelvic floor modifications and prolapse risk factors in postmenopausal women. Menopause (New York, NY). 2010;17(1):204-12.

Moalli PA, Shand SH, Zyczynski HM, Gordy SC, Meyn LA. Remodeling of vaginal connective tissue in patients with prolapse. Obstetr Gynecol. 2005;106(5 Pt 1):953-63.

Giri A, Hartmann KE, Hellwege JN, Velez Edwards DR, Edwards TL. Obesity and pelvic organ prolapse: a systematic review and meta-analysis of observational studies. Am J Obstetr Gynecol. 2017;217(1):11-26.

Kudish BI, Iglesia CB, Sokol RJ. Effect of weight change on natural history of pelvic organ prolapse. Obstetr Gynecol. 2009;113(1):81-8.

Myers DL, Sung VW, Richter HE, Creasman J, Subak LL. Prolapse symptoms in overweight and obese women before and after weight loss. Female Pelvic Med Reconstructive Surg. 2012;18(1):55-9.

Weber AM, Walters MD, Ballard LA, Booher DL, Piedmonte MR. Posterior vaginal prolapse and bowel function. Am J Obstetr Gynecol. 1998;179(6 Pt 1):1446-9.

Spence-Jones C, Kamm MA, Henry MM, Hudson CN. Bowel dysfunction: a pathogenic factor in uterovaginal prolapse and urinary stress incontinence. Bri J Obstetr Gynaecol. 1994;101(2):147-52.

Vergeldt TF, Weemhoff M, IntHout J, Kluivers KB. Risk factors for pelvic organ prolapse and its recurrence: a systematic review. Int Urogynecol J. 2015;26(11):1559-73.

Lince SL, van Kempen LC, Vierhout ME, Kluivers KB. A systematic review of clinical studies on hereditary factors in pelvic organ prolapse. Int Urogynecol J. 2012;23(10):1327-36.

Carley ME, Schaffer J. Urinary incontinence and pelvic organ prolapse in women with Marfan or Ehlers Danlos syndrome. Am J Obstetrics Gynecol. 2000;182(5):1021-3.

McIntosh LJ, Mallett VT, Frahm JD, Richardson DA, Evans MI. Gynecologic disorders in women with Ehlers-Danlos syndrome. J Society Gynecol Investigation. 1995;2(3):559-64.

Lukanovic A, Drazic K. Risk factors for vaginal prolapse after hysterectomy. Int J Gynaecol Obstetr. 2010;110(1):27-30.

Bump RC, Mattiasson A, Bø K. The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. Am J Obstetr Gynecol. 1996;175(1):10-7.

Persu C, Chapple CR, Cauni V, Gutue S, Geavlete P. Pelvic Organ Prolapse Quantification System (POP-Q) - a new era in pelvic prolapse staging. J Med Life. 2011;4(1):75-81.

Dietz HP. Ultrasound in the assessment of pelvic organ prolapse. Best Practice Res Clin Obstetr Gynaecol. 2019;54:12-30.

Jelovsek JE, Maher C, Barber MD. Pelvic organ prolapse. Lancet. 2007;369(9566):1027-38.

Handa VL, Garrett E, Hendrix S, Gold E, Robbins J. Progression and remission of pelvic organ prolapse: a longitudinal study of menopausal women. Am J Obstetr Gynecol. 2004;190(1):27-32.

Mahajan ST, Elkadry EA, Kenton KS, Shott S, Brubaker L. Patient-centered surgical outcomes: the impact of goal achievement and urge incontinence on patient satisfaction one year after surgery. Am J Obstetr Gynecol. 2006;194(3):722-8.

Li C, Gong Y, Wang B. The efficacy of pelvic floor muscle training for pelvic organ prolapse: a systematic review and meta-analysis. Int Urogynecol J. 2016;27(7):981-92.

Hagen S, Stark D, Glazener C. Individualised pelvic floor muscle training in women with pelvic organ prolapse (POPPY): a multicentre randomised controlled trial. Lancet. 2014;383(9919):796-806.

Rahn DD, Good MM, Roshanravan SM. Effects of preoperative local estrogen in postmenopausal women with prolapse: a randomized trial. J Clin Endocrinol Metab. 2014;99(10):3728-36.

Weber MA, Kleijn MH, Langendam M, Limpens J, Heineman MJ, Roovers JP. Local Oestrogen for Pelvic Floor Disorders: A Systematic Review. PloS one. 2015;10(9):e0136265.

Guerette NL, Peterson TV, Aguirre OA, VanDrie DM, Biller DH, Davila GW. Anterior repair with or without collagen matrix reinforcement: a randomized controlled trial. Obstetrics Gynecol. 2009;114(1):59-65.

Chinthakanan O, Miklos JR, Moore RD. Laparoscopic Paravaginal Defect Repair: Surgical Technique and a Literature Review. Surgical Technol Int. 2015;27:173-83.

Maher CF, Feiner B, DeCuyper EM, Nichlos CJ, Hickey KV, O'Rourke P. Laparoscopic sacral colpopexy versus total vaginal mesh for vaginal vault prolapse: a randomized trial. Am J Obstetr Gynecol. 2011;204(4):360.e361-7.

Wise J. Surgical mesh for stress urinary incontinence to be halted immediately in England. BMJ. 2018;362:k3035.