Renal & Urology / Cyoceles and Other Pelvic Floor Abnormalities

Question 1

What is a cystocele?

Answer 1

A hernia in which the urinary bladder protrudes through the wall of the vagina

Question 2

What are the urinary symptoms of a cystocele?

Answer 2

Stress incontinence or incomplete voiding

Question 3

What causes a cystocele?

Answer 3

• Significant or repeated exertion (heavy lifting, childbirth, straining with bowel movement) creating increased abdominal pressure
• sometimes accompanied by a decrease in estrogen (keeps pelvic floor muscles strong)

Question 4

What is an Enterocele?

Answer 4

Protrusion of bowel into the vaginal canal, which may occur after hysterectomy. May cause lower back pain

Question 5

What is a urethroceles?

Answer 5

Protrusion of urethra into vaginal canal. May cause incontinence

Question 6

What is a rectocele?

Answer 6

The front part of the rectum bulges into the vagina. May cause dyspareunia, constipation, and incomplete defecation. Patients sometimes need to use manual pressure against posterior vaginal wall or perineum in order to defecate.

Question 7

These pelvic floor abnormalities are graded by their degree of protrusion relative to the vaginal introitus (vaginal opening). Describe Grade I

Answer 7

Protrusion that does not reach the introitus

Question 8

These pelvic floor abnormalities are graded by their degree of protrusion relative to the vaginal introitus (vaginal opening). Describe Grade II.

Answer 8

Protrusion reaches introitus

Question 9

These pelvic floor abnormalities are graded by their degree of protrusion relative to the vaginal introitus (vaginal opening). Describe Grade III

Answer 9

Protrusion goes beyond introitus

Question 10

What is uterine prolapse?

Answer 10

• descent of the uterus from its normal position into the vaginal canal causing discomfort and pain
• dyspareunia
• incontinence
• recurring urogenital infections

Question 11

What physical exam maneuvers allow visualization of pelvic floor defects?

Answer 11

• A single blade speculum is used to apply pressure to the vaginal wall.
• Posterior defects are seen with pressure applied to the anterior wall.
• Anterior defects are seen with pressure applied to the posterior wall.
• Sometimes the patient has to Valsalva or stand up to make the abnormality detectable.

Question 12

What is a pessary?

Answer 12

• A device inserted in the vagina that is used to support the vagina, uterus, bladder, and or rectum.
• It is used to treat pelvic floor defects.

Question 13

What is the definitive treatment of pelvic floor defects?

Answer 13

Surgery