Pelvic Floor Ultrasound: The Cystocele

Types of cystocele:

  • Medial
  • Lateral
  • Combined mediolateral
  • Apical

Symptoms of anterior vaginal wall prolapse like incomplete bladder emptying or feeling of vaginal bulge are frequent when:

  • The coordinate “Ba” on POPQ descends at least as low as 0.5cm cranially of the hymenal ring (speculum-exam).
  • The bladder descends at least 10mm below the symphysis pubis (pelvic floor sonography).

Differential diagnosis:

  • Vaginal inclusion cysts
  • Gartner-Duct cyst
  • Urethral diverticulum
  • Urethrocele
  • Anterior enterocele
Cystocele on pelvic floor ultrasound. R: rectum, V: vagina, B: bladder.
The same cystocele during valsalva.

Bibliography

  • Dietz HP. Ultrasound in the assessment of pelvic organ prolapse. Best Pract Res Clin Obstet Gynaecol. 2019;54:12-30. doi:10.1016/j.bpobgyn.2018.06.006
  • Lamblin, G., Delorme, E., Cosson, M., & Rubod, C. (2016). Cystocele and functional anatomy of the pelvic floor: review and update of the various theories. International urogynecology journal27(9), 1297–1305. https://doi.org/10.1007/s00192-015-2832-4

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