Diagnosis of cystocele type by clinical examination and pelvic floor ultrasound

Abstract

Objectives To use the International Continence Society pelvic organ prolapse quantification (ICS POP-

Clinical Importance and Surgical Outcomes of Green Type III Cystocele in Women With Anterior Vaginal Prolapse

“…Overactive bladder symptoms were defined as affirmative responses to urgency with or without urgency incontinence. Questions 3 (eg, Do you usually have a bulge or something falling out that you can see or feel in the vaginal area?) from the short form of the Pelvic Floor Distress Inventory 13 were selectively evaluated for indications of vaginal bulging using a 4‐point rating scale: 1, not at all; 2, slightly; 3, moderately; and 4, greatly.…”

“…The sonographic assessments consisted of identification of Green type III cystocele (Figure 1), as well as localizations of the bladder neck and genital hiatus in the polar coordinate system, indicating their positions relative to the symphysis pubis (Figures 2 and 3). 7 , 15 , 16 Green type III cystocele was indentified on the basis of the descriptions by Chantarasorn and Dietz 3 as descent of the bladder base (cystocele) and bladder neck with an intact retrovesical angle (<140°). Any descent of the bladder base (cystocele) and bladder neck with an open retrovesical angle (≥140°) was not regarded Green type III cystocele.…”

“…Power calculations were performed on the basis of literature data regarding the incidence of Green type III cystocele 3 and success rates of the two procedures 10 . For the respective incidences of Green type III and II cystocele of 18.1% and 33.0%, respectively, a sample size of 105 women in each group was required to achieve 80% power and a 2‐sided significance level of 5%.…”

“…Cystocele is a common subtype of pelvic organ prolapse (POP) 1 and has been radiologically categorized into 3 types by Green 2 . Green type III cystocele (Figure 1), defined as a cystocele with retrovesical angle of less than 140°, 2 , 3 can be effectively distinguished by physical examination and sonography 3 and is associated with levator trauma due to childbirth, voiding dysfunction, prolapse, recurrent prolapse, and a larger genitohiatal angle on sonography 3 – 7 …”

ACR Appropriateness Criteria Pelvic Floor Dysfunction

“…Imaging can distinguish between a cystocele with urethral hypermobility and a cystocele without urethral rotation [40]. Rotation and descent of both the urethrovesical junction and bladder are associated with stress incontinence [22].…”