cystocèle

A cystocele, or cystocèle, also known as an anterior vaginal wall prolapse, is a descent of the bladder into the vaginal canal caused by weakness or damage to the pelvic floor supports. It occurs when the tissues that normally hold the bladder in place stretch or weaken, allowing the bladder to bulge into the front wall of the vagina.

Symptoms commonly include a sensation of vaginal bulge, pelvic pressure, and urinary symptoms such as stress incontinence, difficulty emptying the bladder, urgency, or recurrent infections. Some individuals experience dyspareunia. The severity of symptoms does not always correlate with the amount of bladder protrusion.

Causes and risk factors include vaginal childbirth, aging and menopause, obesity, chronic coughing or constipation, heavy lifting, and prior pelvic surgery. The condition often coexists with other pelvic organ prolapses, reflecting overall weakening of the pelvic floor.

Diagnosis is usually based on a pelvic examination. Staging ranges from mild to severe based on the extent of bladder descent. Urodynamic testing or bladder ultrasound may be used in selected cases to assess function and guide treatment.

Management includes conservative options such as pelvic floor physical therapy (Kegel exercises), vaginal pessaries, and lifestyle measures to reduce abdominal pressure. Surgery is considered for persistent or bothersome prolapse. Procedures include anterior repair (anterior colporrhaphy) performed vaginally or abdominally. Use of mesh has declined due to safety concerns; alternative grafts and suspension procedures may be employed to provide additional support when indicated.

Prognosis is generally favorable with appropriate treatment, but prolapse may recur, especially in older individuals. Recurrence rates vary by procedure and patient factors. Prevention focuses on maintaining pelvic floor strength and avoiding activities that excessively increase intra-abdominal pressure.