What is a Cystocele?
Cystocele (bladder prolapse) can be defined as prolapse of the bladder into the vagina or out of the vagina in advanced cases.
It is a kind of herniation of the urinary bladder into the vagina.
Although it is generally seen in women, rarely herniation of the bladder to the groin area can also be seen in men.
It develops as a result of weakening of the ligaments that hold the urinary bladder in the abdomen and pelvic floor. It is most common in adult women who have had a difficult and multiple birth. It usually occurs after menopause. Situations that increase intra-abdominal pressure such as cough, sneezing, heavy lifting trigger the formation of cystocele.
In addition, it can rarely be seen after menopause due to the effects of hormones in women who have not given birth.
What are the Symptoms of Bladder Prolapse?
The most basic symptoms of cystocele (bladder prolapse) are the feeling of a swelling in the vagina or a swelling in manual control. In advanced cases, it happens in the form of an organ coming out of the vagina.
The clinic becomes more prominent especially in cases where intra-abdominal pressure increases such as cough, sneezing, and heavy lifting. In addition, in cases such as sters-like burning cough, sneezing, climbing stairs, laughing, administration can be seen. Sometimes, as a result of the bladder sagging and the obstruction of the external urinary tract due to displacement, there are symptoms such as difficulty in administration, even urinating by pressure on the sagging bladder, frequent urination.
Even kidney failure may develop due to inability to urinate. In this case, emergency intervention may be required.
How Are Cystocele Patients Evaluated?
In a patient presenting with suspicion of bladder prolapse, we first question when it started, whether there are other complaints, whether there are chronic diseases such as chronic obstructive pulmonary disease (COPD), diabetes, and the surgeries he has undergone.
Then, we make a detailed physical examination to the patient and determine the degree of cystocele. Cystocele can be roughly graded as mild, moderate, or severe.
In mild cases, there may be no serious complaints. There is a slight swelling sensation in the vagina and it is palpable by hand. There may or may not be urinary incontinence.
In moderate cases, the bladder reaches the opening of the vagina, but does not go out.
In physical examination, when the patient is strained, the bladder can be seen in the mouth of the vagina. In severe cases, the bladder goes out of the vagina and is directly visible.
After the patient is evaluated with both history and physical examination, treatment principles are determined.
How Is Bladder Prolapse Treated?
The patient’s age, comorbidities and the degree of cystocele are very important in determining the treatment principles.
In mild cases, if the patient is obese, weight loss, heavy lifting, and urinary incontinence, we can follow up by giving exercises to strengthen the pelvic floor.
If necessary, we can support it with anticholinergic drugs. However, if the patient wants and does not respond to medical treatment and urinary complaints persist, surgical treatment can be performed.
In surgical treatment, operations such as TOT and TVT that support urinary retention should be added in addition to cystocele surgery.
It is important that moderate cases have a problem with urine output. In addition, urinary incontinence should be evaluated. As a result of all these, it is necessary to add urinary incontinence surgery in addition to cystocele surgery. In severe cases, the treatment is definitive surgery.
The surgical procedure can be performed with a vaginal approach or successfully performed with open, laparoscopic or robotic surgery through the abdomen.
As a result, cystocele is a disease of various degrees, especially in women after menopause.
It is more common in those who have given birth too much. There may be complaints such as frequent urination, difficulty in urinating, urinary incontinence. The patient can be evaluated well and treated according to the degree.