Definition of Cystocele

A cystocele is the protrusion or prolapse of the bladder into the vagina. This happens when the muscular wall that separates the two structures weakens, allowing the bladder to droop and push towards the vagina. This condition may cause some discomfort and bladder emptying problems. A number of surgical interventions are available to treat cystoceles.

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Contributing Factors

A cystocele may be caused by muscle straining during childbirth, or by straining cause by heavy lifting and bowel movements. Estrogen, a hormone that helps strengthen the muscles around the vagina, may decrease in amount during menopause. Other factors that may have contibuted to this condition include aging, a prior hysterectomy, chronic constipation, and ongoing strenous physicial activity.

Symptoms of bladder prolapse include but not limited to:

Surgery is generally not performed unless the symptoms of the prolapse have begun to interfere with daily life. A staging system is used to grade the severity of a cystocele. A stage I, II, or III prolapse descends to progressively lower areas of the vagina. A stage IV prolapse descends to or protrudes through the vaginal opening. Surgery is generally reserved for stage III and IV cystoceles.

Diagnosis of bladder prolapse

Physical examination is most often used to diagnose a cystocele. A speculum is inserted into the vagina and the patient is asked to strain or sit in an upright position; this increase in intra-abdominal pressure maximizes the degree of prolapse and aids in diagnosis. The physician then inspects the walls of the vagina for prolapse or bulging.

In some cases, a physical examination cannot sufficiently diagnose pelvic prolapse. For example, cystography may be used to determine the extent of a cystocele; the bladder is filled by urinary catheter with contrast medium and then x rayed. Ultrasound or magnetic resonance imaging may also be used to visualize the pelvic structures.

Women who have gone through menopause may be given six weeks of estrogen therapy prior to surgery; this is thought to improve circulation to the vaginal walls and thus improve recovery time. Antibiotics may be administered to decrease the risk of postsurgical infection. An intravenous (IV) line is placed and a Foley catheter is inserted into the bladder directly preceding surgery.

Treatment

A cystocele is when the bladder falls down and often becomes visible. Urinary leakage often accompanies a cystocele. Cystoceles may cause pelvic pressure or may just be unsightly. Cystocele repair,also called Anterior Repair or Anterior Colporrhaphy, is the surgical reduction of the bulge to place the bladder back into its normal anatomic location. The traditional repair of overlapping tissues with suture unfortunately has a very high failure rate ranging from 25 to 60 percent.

More modern surgery treats cystoceles as a hernia of the bladder into the vagina, hence, the use of mesh or donor tissues as a patch or graft has been gaining steady acceptance. We have some of the most extensive experience in this type of surgery in Beverly Hills Medical Group with success rates of about 90% in our hands. Cystocele Repair is done in the surgery center or operating room under general, regional, or local anesthesia. The procedure takes 60 minutes to perform. Most insurance companies cover this procedure.

The goal of surgery for a cystocele repair is to return the bladder and urethra to their proper position, and is usually performed by a surgeon who specializes in gynecology or urology. The cystocele repair can be accomplished either laparoscopically, using a camera and other tools inserted through a small incision. The surgery is usually minimally invasive, and the choice of either surgical option is dependent on the severity and placement of the cystocele.

Cystocelerepair involves the restoration of the ligaments and tissue required to strengthen the muscle wall that holds the bladder and urethra in place. Additionally, some women who have a cystocele often also have other pelvic organ prolapse. This can usually be repaired at the same time.

Surgical cystocele repair is usually not the first option for those diagnosed with a cystocele. The severity of the symptoms usually dictates the course of treatment. Many cystoceles can be managed through Kegel exercises to strengthen the pelvic muscles, hormonal replacement therapy, or the use of a pessary support device. Surgical cystocele repair is normally reserved for those who exhibit intense symptoms that interfere with normal daily activities.

Length of the Surgery

The surgery itself can take anywhere from 45 minutes to 2 hours or more. The length depends on the repair that need to be made.

Outcome

Typically, women who have had cystocele or rectocele repair find that they have much improved bladder or bowel control.

Recovery and Maintenance

Normal activities can be resumed in approximately six weeks. You will likely experience vaginal discomfort for 1-2 weeks following the surgery. You will typically be given a prescription for medication to help relieve this discomfort. Care must be taken to limit heavy lifting or long periods of standing for about three months, as too much activity too soon could cause the prolapse to recur.

  • Avoid lifting anything that weighs more than 10 pounds for about a month.
  • Avoid sexual intercourse for about a month.
  • Avoid inserting anything into the vagina (eg, tampons) for about a month.
  • Have someone to help you at home for a few days following the surgery.

Possible Complications

Some risks associated with cystocele and rectocele repair include the following:

  • Adverse reaction to anesthesia
  • Infection
  • Heavy bleeding
  • Accidental damage to vagina, rectum, and bladder
  • Accidental damage to nearby organs

Accidental injuries during these procedures are extremely rare. In the unlikely event that an injury did occur, the doctor would usually fix the problem during the surgery.

You may call Beverly Hills Medical Group if any of the following Occurs after surgery:

  • Any signs of infection, such as fever, chills, or foul-smelling discharge from the vagina
  • Unusually heavy vaginal bleeding
  • Worsening pain
  • Any unusual symptoms

Morbidity and Mortality Rates

The risk of cystocele recurrence following surgical repair depends on the procedure used to treat it. Anterior colporrhaphy is associated with a 020% rate of recurrence; this rate is higher when colporrhaphy is combined with other surgical procedures. Abdominal paravaginal repair results in a 5% chance of recurrence, while vaginal paravaginal repair has the highest recurrence rate (722%).

Frequently Asked questions:

Q: Can Kegels completely correct a mild bladder prolapse or cystocele?

A: Kegels execises may help improve the condition and reduce the exisiting symptoms, but for some cases exercise alone does not correct problem

Q: Ever since I got cystocele of the bladder and rectocele (mild, stage 1), I do not have good muscle tone (down there) anymore. Will Kegels Help correct this?

A: Kegels will strengthen the floor of your peritoneal area, but you might need surgery to keep the bladder and rectum in place.

Q: Is there a chance of mesh erosion in paravaginal cystocele repair via laparoscopy?

A: yes there could be a chance but still proper following of post operative instructions and maintenance from your physician will prevent the problem.

Q: I have both a cystocele and a rectocele. What type of doctor can repair these?

A: You should go see a colon/rectal specialist or better yet, a urogynecologist, and there are reconstructive surgical procedures to correct this. A Urogynecologist is an Obstetrician/Gynecologist who has specialized in the care of women with Pelvic Floor Dysfunction. The Pelvic Floor is the muscles, ligaments, connective tissue, and nerves that help support and control the rectum, uterus, vagina, and bladder. The pelvic floor can be damaged by childbirth, repeated heavy lifting, chronic disease or surgery. You can contact the Beverly Hills Medical Group for a physician near you by going to the following web site: bhmg10@gmail.com

Q: How do I know if I’m doing Kegels correctly? I am so weak from cystocele that I cannot stop my urine stream?

A: The ONLY way to be sure you’re doing the exercise correctly is if you are able to stope the flow of urine when you contratc your muscles. The Kegels are directly responsible for this action, so until you can do that you won’t know which muscles you need to contract. You may need to talk to your doctor. There may be some other type of exercise that can be done.

Q: Can I get pregnant with a third degree cystocele? What are the precautions I should take while trying for?

A: Your doctor may recommend a surgery to correct the problem before you start trying to get pregnant.

Q: Has anyone ever corrected a mild stage 1 cystocele/rectocele by doing Kegels?

A:The purpose of the Kegels is to treat the symptoms, usually urinary incontinence.

Q: Can a cystocele/rectocele/enterocele surgery be done under a spinal anesthesia?

A: It can be done under spinal, but you will need to discuss things with your anesthetist and Surgeon.

Q: After surgery for a cystocele, rectocele, and urethral sling, how much walking and stair climbing can I do?

A: Take it easy, and rest. There’s nothing important enough to risk your health for. Following instructions from your doctors is still the key for best recovery.