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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.
History and Clinical Investigations: Patient Complaints in Perspective
Published in Victor Gomel, Bruno van Herendael, Female Genital Prolapse and Urinary Incontinence, 2007
The relaxation of the anterior wall results in an urethrocele (urethra and bladder neck) and a cystocele. While an urethrocele results in stress incontinence, a cystocele without descent of the bladder neck causes obstructed micturition.
Complications of Female Incontinence Surgery
Published in Kevin R. Loughlin, Complications of Urologic Surgery and Practice, 2007
Ureteral ligation is another potential complication of transvaginal cystocele repair, but this complication should always be recognized and remedied intraoperatively. Cystourethroscopy is absolutely indicated, and visualization of urine efflux should be observed from both ureteral orifices. Difficulty visualizing efflux may be overcome by administration of intravenous indigo carmine, and fluid challenge. Lack of visualization should be further investigated with attempted passage (and then removal) of a ureteral stent. Inability to pass a stent implies ureteral ligation, and requires removal of the offending suture, which usually involves the cardinal ligament or posterior pubocervical fascial suture(s). Subsequent confirmation of urine reflux should suffice, without the need for further evaluation or treatment.
Complications and clinical outcomes of laparoscopic sacrocolpopexy for pelvic organ prolapse
Published in Journal of Obstetrics and Gynaecology, 2021
Hirotaka Sato, Hirokazu Abe, Atsushi Ikeda, Tomoaki Miyagawa, Katsuhiko Sato
The anatomical result in terms of objective outcomes reported in our study was 93.5% at 12 months, which was similar to the results of another study by Sarlos et al. (2014). We encountered three cases of recurrent cystocele; two cases occurred at the 12-month follow-up, and one at the six-month follow-up. The two patients were asymptomatic and were placed under observation. The patient with recurrence at six months had symptomatic prolapse and was treated with a pessary. Generally, most recurrences occur in the anterior compartment (Maher et al. 2011; Vandendriessche et al. 2015; Vandendriessche et al. 2017). During LSC, we performed the anterior vaginal wall dissection procedure reported by Abdullah et al. (2017), i.e. we performed dissection until we reached the boundary between the trigone of the bladder and the urethra and anchored the mesh to the anterior vaginal wall using a five-point fixation with non-absorbable sutures. It was speculated that insufficient anchoring to the anterior vaginal wall was a factor in cases of recurrence.
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.
The transvaginal mesh: an overview of indications and contraindications for its use
Published in Expert Review of Medical Devices, 2023
Alessandro Ferdinando Ruffolo, Marine Lallemant, Sophie Delplanque, Michel Cosson
POP is the result of laxity in the four main suspensory pelvic ligaments (pubourethral, cardinal, arcus tendinous of pelvic fascia and uterosacral) and of perineal body defects [44]. The bladder (cystocele), the uterus (hysterocele), the pouch of Douglas (elytrocele) and the rectum (rectocele) may be involved in the vaginal prolapse, differently from the rectal prolapse that is an exteriorization of the rectum through the anal orifice. The restoration of ligaments’ length and tension leads to anatomical and functional improvement [44].