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Urogenital prolapse
Published in David M. Luesley, Mark D. Kilby, Obstetrics & Gynaecology, 2016
Sushma Srikrishna, Dudley Robinson
Urogenital prolapse is classified anatomically depending on the site of the defect and the pelvic viscera that are involved. Urethrocele: prolapse of the lower anterior vaginal wall involving the urethra only.Cystocele: prolapse of the upper anterior vaginal wall involving the bladder. Generally, there is also associated prolapse of the urethra and hence the term cystourethrocele is used.Uterovaginal prolapse: this term is used to describe prolapse of the uterus, cervix and upper vagina.Enterocele: prolapse of the upper posterior wall of the vagina, usually containing loops of small bowel. A traction enterocele is secondary to uterovaginal prolapse, a pulsion enterocele is secondary to chronically raised intraabdominal pressure, and an iatrogenic enterocele is caused by previous pelvic surgery. An anterior enterocele may be used to describe prolapse of the upper anterior vaginal wall following hysterectomy.Rectocele: prolapse of the lower posterior wall of the vagina involving the anterior wall of the rectum.
Investigation of pelvic floor disorders
Published in Climacteric, 2019
Pelvic floor ultrasound can also be used to evaluate descent of the vaginal walls, the uterus, the small bowel, and the rectum. For women with anterior vaginal prolapse, ultrasound may distinguish between a true cystocele from other conditions such as urethral diverticulum, Gartner duct cyst, and anterior enterocele24. For those women with cystocele, ultrasound may distinguish between those who have cystourethrocele (Green type II cystocele) and those with an intact retrovesical angle (Green type III cystocele)37. The first is associated with good urine flow rates and USI, while the latter is associated with voiding dysfunction and a low likelihood of SUI38. Ultrasound can be particularly useful for women with posterior vaginal wall prolapse. In these cases, ultrasound may distinguish a true ‘rectocele’ due to the weakening of the rectovaginal fascia from an enterocele, a rectal intussusception, or just a deficient perineum. Rectal intussusception, a condition that is found in approximately 4% of patients in a urogyneoclogy clinic, is strongly associated with symptoms of obstructed defecation39. The preoperative diagnosis of this condition is important for planning the optimal surgical technique. Finally, on translabial ultrasound, a descent of the bladder of 10 mm and of the rectum or uterus >15 mm below the symphysis pubis at maximum Valsalva manoeuvre are strongly associated with POP symptoms and are proposed as cut-off values for the ultrasonic diagnosis of significant prolapse40,41.