Zystozele

Dynamic
magnetic resonance imaging of the female pelvic floor—a pictorial review. Moderate cystocele with urethral hypermobility. (a, b) Sagittal midline TrueFISP images at rest (a) and during evacuation (b), demonstrating descent of the bladder during evacuation (green line—3.8 cm) below the PCL (red line), as well as horizontalization of the urethral axis during defecation (white arrows). Note also an anterior rectocele in (b)
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Dynamic
magnetic resonance imaging of the female pelvic floor—a pictorial review. Descending perineal syndrome with tricompartimental prolapse. (a, b) Sagittal midline TruFISP images at rest (a) and during evacuation (b). H line (blue line) measures 7.7 cm (a) and 9.8 cm (b) and the M line (green line) measures 2.3 cm (a) and 4.5 cm (b), demonstrating widening and descent of the levator hiatus, even at rest but aggravating during defecation. It is also associated with tricompartimental prolapse, with a severe cystocele and a severe uterine everted prolapse. Note the verticalization of the levator plate (white arrow). Another interesting finding is that the rectal contrast is only partially expelled (b), because the mass effect by both the cystocele and uterine prolapse induces mechanical posterior obstruction (dilated rectum filled with ultrasound gel) causing constipation and incomplete evacuation (*). (c) Axial T2-TSE image at the pubic symphysis plane showing bilateral ureterohydronephosis causes by the cystocele (red arrows)
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A cystocele, also known as a prolapsed bladder, is a form of pelvic organ prolapse where the bladder descends inferiorly and posteriorly into the vagina and perineum. It may be accompanied by prolapse of other pelvic organs.

Radiographic features

CT / MRI 

Sagittal images are particularly useful where the inferior margin of the bladder is often at a lower position than the pubococcygeal line . Imaging during strain is suggested to improve detection . Additional features that may be detected during dynamic pelvic floor MRI are changes in the urethral angle and involuntary loss of urine into the urethra during defecation.

Fluoroscopic cystocolpoproctography

Instillation of bladder contrast prior to a fluoroscopic pelvic floor study allows evaluation of bladder descent during evacuation.

Treatment and prognosis

A cystocele alone can be treated with a retropubic (Burch) colposuspension, which comprises the suspension of the lateral aspects of the bladder from the pelvic sidewalls. Once the fascia is detached from the tendinous arch, a paravaginal fascial repair is added .

Differential diagnosis

Consider

See also

Siehe auch:
und weiter:
Assoziationen und Differentialdiagnosen zu Zystozele:
Vaginalpessar
 
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