Cystocele


Normal
cystocele
Fig. 1. Cystocele. Prolapse of the bladder wall with the front wall of the vagina.

Cystocele is a prolapse of the bladder with the front wall of the vagina. When cystocele occurs frequently omission and urethra - urethrocele.
Cystocele is the result of relaxation of the urogenital diaphragm, pelvic insufficiency of fiber, observed after tearing of the perineum in childbirth at offset pelvic organs of the omission and the loss of the uterus, vagina (see), in the wrong position of the uterus (the deviation her backwards).
At first, the disease is manifested by the protrusion of the vaginal walls only when natureway, subsequently outside of the genital slit can be determined education up to size of a fist.
The main complaints of the patients are to urination disorder: incomplete emptying of the bladder, difficulty urinating, frequent urges to urinate, and sometimes incontinence of urine when laughing or coughing.
Treatment - prompt, aimed at restoring the normal provisions of the bladder and urethra, strengthening the pelvic floor. The postoperative period - see Colpoperineorrhaphy.
Prevention cystocele is therapeutic exercises, strengthening the pelvic floor muscles are conducted in all periods of a woman's life, including pregnancy, timely recovery intact tissues crotch and pelvic floor with tears in childbirth.

Cystocele (cystocele; from the Greek. kystis - bladder and kele - hernia - the rupture of the bladder. There is also a hernia back wall of the urethra (uretrocele). Education Centners, urethrocele goes simultaneously with the lowering of the anterior wall of the vagina (Fig. 1), and at urethrocele prolapse of the vaginal walls starts from the external urethral orifice. The degree of prolapse different. Mild cases can be detected only during physical strain, heavy (bulging vaginal wall outside of the genital slit) - even at rest. Very often omission of the front wall of the vagina is combined with the lowering of the rear wall.
The etiology and pathogenesis most often associated with relaxation and violation of the integrity of the muscular-fascial plates pelvic floor [Alban, Chandler (J. Halban, J. Tandler)], which can lead breaks crotch in childbirth, wrong position of the uterus, especially retroflexio-versio, pelvic insufficiency of fiber, especially paracervical, etc.
When intra-abdominal pressure rises for a long time, gradually comes muscle wasting; relaxation them and leads to dehiscence of the urino-genital slit, and therefore increases the possibility of omission and the loss (K. K. Skrobanski) deprived of the support of the bladder. This relaxation of the pelvic floor muscles may occur due to poor anatomical development, congenital underdevelopment, functional insufficiency or in cases when m. levator ani injured or even broken.
The origin cystocele plays a significant role in the weakening (tensile) connective tissue formations, located between the uterus, bladder and symphysis (retinaculi uteri), often observed after birth. In these cases, widens the urethra and together with bladder moves down, forming a cystocele with urethrocele.
In more rare cases falls down only the front part of the vaginal walls together with the advanced urethra (urethrocele), and the bladder remains in place. The formation of such isolated omission may be important excessive depth excavatio vesico-uterina.
The clinical picture. Outside of the genital slit is determined by education up to the knuckle.
Due to permanent injury to the mucous membrane of the fallen plot is subject to change. Multi-layer flat epithelium rogowiec, smooth out wrinkles, easily cracks, bruises, sores. The main complaints of the patients are to urination disorder (incomplete emptying of the bladder, difficulty urinating, frequent urges to urinate, and when urethrocele relative urinary incontinence).
In addition, patients report a feeling of constant downward pressure and pain in the rump.
The diagnosis is not difficult. It must be remembered that such an omission (bulging) may be associated with diverticulum of the bladder or urethra that is installed in urologic examination of the patient.