Metricele

Metricele is a term encountered in a minority of obstetric and gynecologic texts to describe a form of pelvic organ prolapse in which uterine tissue herniates through a defect in the anterior vaginal wall. The word combines elements meaning uterus and hernia, and its use has declined in modern practice. Today, many clinicians prefer to describe pelvic organ prolapse by compartment (anterior, apical, or posterior) and by the position of the uterus rather than using metricele as a distinct diagnostic label.

Classification and causes are not standardized, but metricele is generally considered a manifestation of pelvic floor weakness. Risk factors include multiple vaginal births, aging, obesity, chronic coughing, and conditions that increase intra-abdominal pressure. Pathophysiology involves weakening or disruption of pelvic ligaments and support structures, such as the uterosacral and cardinal ligaments, along with pelvic floor muscle dysfunction.

Clinical features typically include a vaginal mass that may be felt or observed on examination, along with pelvic pressure, discomfort, dyspareunia, and sometimes urinary symptoms. Diagnosis is based on a comprehensive pelvic examination; imaging such as ultrasound or MRI can be used to assess uterine orientation and exclude other prolapse components if needed.

Management is tailored to severity and patient preference. Conservative options include pelvic floor muscle training and the use of a pessary. Surgical approaches focus on restoring pelvic support and may involve anterior repair, apical suspension procedures, or hysterectomy in select cases. Recurrence and ongoing pelvic floor dysfunction are considerations in prognosis. In current practice, metricele is rarely used as a separate diagnosis, with emphasis placed on broader prolapse classification and individualized management.