Cystocele

Cystocele is a protrusion of the urinary bladder into the vagina resulting from weakness or damage to the anterior pelvic floor and its connective tissue supports. It is a type of pelvic organ prolapse and is most common in women who have given birth, though it can occur after gynecologic surgery, pelvic radiation, or with chronic increased intra-abdominal pressure.

Risk factors include childbirth, multiple pregnancies, menopause, obesity, chronic cough, constipation, heavy lifting, smoking, and prior pelvic surgery. Connective tissue disorders may predispose to prolapse.

Symptoms vary. Some women have a feeling of vaginal fullness or bulging, pelvic pressure, or discomfort, especially with standing or strain. Urinary symptoms can include stress incontinence, urinary frequency or urgency, incomplete bladder emptying, or recurrent urinary tract infections. Some cases are asymptomatic and discovered on examination.

Diagnosis is typically clinical through a pelvic examination. A cough test or provocation may reveal prolapse. Quantification systems such as POP-Q help stage severity; imaging or urodynamic studies are used when urinary symptoms are prominent or to plan surgery.

Management ranges from conservative to surgical. For mild symptoms, pelvic floor physical therapy, vaginal pessaries, and lifestyle measures (weight reduction, treatment of constipation, smoking cessation) are first-line. Topical estrogen may improve tissue quality in postmenopausal women. Surgery is considered for significant or bothersome prolapse or failed conservative therapy. Procedures include anterior repair (anterior colporrhaphy), other pelvic floor reconstructions, or sacrocolpopexy; the use of mesh has declined in many settings due to safety concerns.

Prognosis is generally favorable with appropriate treatment, but recurrence is possible. Prevention focuses on maintaining pelvic floor strength and avoiding prolonged straining.