A clinical and urodynamic study of patients with varying degrees of cystocele

Dynamic morphological changes in the anterior vaginal wall before and after laparoscopic Burch colposuspension in primary urodynamic stress incontinence

“…On ultrasound cystourethrography, hypermobility of the bladder neck is presumed to be etiologically associated with stress urinary incontinence6, 7, 10, 13, funneling of the bladder neck signifies the possible coexistence of poor urethral closure pressure7, 17 and cystocele may associate with urethral obstruction or urethral narrowing1–3, 7, 13. Clinically, cystocele is defined as a bulging anterior vaginal wall with overhanging bladder demonstrable during a pelvic examination and is common and not specific for any particular bladder anomaly.…”

“…The complex relationship between anterior vaginal wall defect and lower urinary tract symptoms has yet to be clearly defined. It has been known that women with mild and moderate pelvic floor relaxation often complain of stress incontinence, whereas women with severe uterovaginal prolapse rarely complain of incontinence1–3. By causing urethral kinking, obstruction or narrowing, prolapsing cystocele was one of the anatomical factors responsible for the continent mechanism in severe uterovaginal prolapse1–3.…”

“…It has been known that women with mild and moderate pelvic floor relaxation often complain of stress incontinence, whereas women with severe uterovaginal prolapse rarely complain of incontinence1–3. By causing urethral kinking, obstruction or narrowing, prolapsing cystocele was one of the anatomical factors responsible for the continent mechanism in severe uterovaginal prolapse1–3. Different types of cystocele may have a different impact on voiding2, 3.…”

“…By causing urethral kinking, obstruction or narrowing, prolapsing cystocele was one of the anatomical factors responsible for the continent mechanism in severe uterovaginal prolapse1–3. Different types of cystocele may have a different impact on voiding2, 3. On ultrasound cystourethrography, a cystocele with opening of the retrovesical angle during stress was associated with improved voiding, whereas a cystocele with intact retrovesical angle had the opposite effect2.…”

“…Additionally, Skala et al 9 had even reported that an uncorrected anatomical defect disclosed by ultrasound was also related to these symptoms. This study was designed to test the following hypotheses: (1) laparoscopic colposuspension can cure a cystocele that descends further than the bladder neck on Valsalva and, therefore, (2) failure to cure cystocele is associated with distinct changes in the urethral or voiding function because of varying effects of the preoperative equivalent reported on urodynamic studies1–3.…”