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Cystocele (Fallen Bladder) Bethesda, MD: National Kidney and Urologic Diseases Information Clearinghouse. 2007. 2 p.

This fact sheet describes cystocele, a condition that occurs when the wall between a woman’s bladder and her vagina weakens and allows the bladder to droop into the vagina. This condition may cause discomfort and problems with emptying the bladder. A bladder that has dropped from its normal position may cause two kinds of problems: unwanted urine leakage and incomplete emptying of the bladder. Written in a question-and-answer format, the fact sheet reviews the causes of cystocele, diagnostic tests that may be used to confirm the presence of a cystocele, and treatment options, which range from no treatment to surgery. The fact sheet includes the contact details for three resource organizations through which readers can get more information and a description of the goals and activities of the National Kidney and Urologic Diseases Information Clearinghouse.

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Urinary Retention. Bethesda, MD: National Kidney and Urologic Diseases Information Clearinghouse. 2007. 8 p.

This fact sheet describes urinary retention, which is defined as the inability to empty the bladder. With acute urinary retention, one cannot urinate at all, even with a full bladder. Acute urinary retention is a medical emergency that requires prompt action. Chronic urinary retention may not seem life-threatening, but it can lead to serious problems and should receive attention from a health professional. Written in a question-and-answer format, the fact sheet reviews the physiology of the urinary tract; considers the causes of urinary retention, which include nerve disease, spinal cord injury, prostate enlargement, also known as benign prostatic hyperplasia (BPH), infection, surgery, medications, bladder stones, cystocele or rectocele, constipation, and urethral stricture; notes the symptoms of urinary retention; diagnostic approaches used to confirm urinary retention, including the patient history and physical examination, urine sample, bladder scan, cystoscopy, radiography and computer tomography (CT) scan, PSA blood test, prostate fluid sample, and urodynamic tests; reviews treatments, including catheterization, treatments to relieve prostate enlargement, and surgery; and notes the complications of urinary retention and its treatments, including urinary tract infections, bladder damage, chronic kidney disease, and incontinence and erectile function after prostate surgery. A final section briefly reviews current research programs in this area. The fact sheet includes the contact details for two resource organizations through which readers can get more information and a description of the goals and activities of the National Kidney and Urologic Diseases Information Clearinghouse. 1 figure.

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Videourodynamics. IN: Atlas of Urodynamics. 2nd ed. Williston, VT: Blackwell Publishing Inc. 2007. pp 62-68.

The purpose of urodynamic testing is to measure and record various physiological variables while the patient is experiencing those symptoms which make up the presenting complaint. Videourodynamics provides the synchronous measurement and display of urodynamic parameters with radiographic visualization of the lower urinary tract and is a precise diagnostic tool for evaluating disturbances of micturition. This chapter on videourodynamics is from an atlas of urodynamics that provides a comprehensive, detailed look at the indications, technology, and use of urodynamics in modern urologic practice. The chapter begins with a brief section describing how videourodynamics can be used and then presents case illustrations, accompanied by figures and black-and-white photographs of actual urodynamic tests. The authors also outline the technique and equipment used. Videourodynamics is used to evaluate overall bladder control; degree of cystocele and urethrocele at rest and with straining; the state of the bladder neck at rest and straining (closed, beaked, or open); the presence of vesicoureteral reflux, bladder or urethral diverticula or fistula; and the site of urethral obstruction. 4 figures. 6 references.

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Has My Bladder Fallen? An Introduction to Pelvic Organ Prolapse. Quality Care. 24(2): 4. 1st Quarter 2006.

This brief article, from a newsletter for people with urinary incontinence, introduces readers to the problem of pelvic organ prolapse (POP). In POP, also called cystocele, the pelvic organs (uterus, bladder, bowels) can move out of position because the walls and supports that should keep them in place have given way. This condition is particularly common in women who have delivered a child vaginally. The author reviews the symptoms, the different terminology that is used to describe different types of POP, how prolapse can be interrelated with urinary incontinence, and surgical and nonsurgical options for treating prolapse. Readers are encouraged to educate themselves and to work closely with their health care providers to find a solution for any pelvic organ prolapse symptoms.

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Urodynamically Defined Stress Urinary Incontinence and Bladder Outlet Obstruction Coexist in Women. Journal of Urology. 171(2): 757-761. February 2004.

The definition and significance of female bladder outlet obstruction (BOO) are poorly understood. This study identified patients with urodynamic evidence of BOO in a cohort of women with stress urinary incontinence (SUI). Of 104 eligible subjects, 19 (18.3 percent) had BOO. Maximum flow rate, mean flow rate, and voided volume were significantly less in the BOO group than in the unobstructed group. Detrusor pressure at maximum flow, maximum detrusor pressure, and post-void residual volume were significantly greater in the BOO group than in the unobstructed group. Etiologies (causes) of BOO identified in the 19 subjects included prior anti-incontinence or prolapse surgery in 6 patients, neurological conditions in 4 patients, cystocele in 2 patients, dysfunctional voiding in 3 patients, and idiopathic (unknown) in 5 patients. The authors conclude that SUI and BOO can coexist even in the absence of common causes of obstruction. Appended to the article are two commentaries. 2 tables. 12 references.

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Pelvic Floor Weakness: When the Bottom Gives Way. Mayo Clinic Health Letter. 20(5): 4-5. May 2002.

This article, from a health information newsletter, reviews the problem of pelvic floor weakness. The strains of daily life and aging can be factors that weaken and stretch muscles, ligaments, nerves, and other tissues supporting the pelvic organs. Once identified, pelvic floor weakness can sometimes be managed with exercises and noninvasive therapies. Often, though, surgical treatment is preferred and even necessary. The article reviews the physiology and anatomy of the pelvic floor muscles, conditions that may result from weakened pelvic floor muscles (uterine prolapse, cystocele, rectocele, enterocele), the symptoms of those conditions, diagnostic tests that may be done, and treatment options. One sidebar reviews the use of Kegel exercises to strengthen the pelvic floor muscles. 1 figure.

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Treating Incontinence with Surgery. In: Parker, W.H., et al. Incontinence Solution: Answers for Women of All Ages. New York, NY: Simon and Schuster. 2002. p.123-149.

Urinary incontinence is the uncontrollable loss of enough urine to cause social or sanitary difficulties. This chapter describes surgical strategies for treating incontinence. The chapter is from a book that offers women up to date medical explanations for incontinence and its treatment. The authors note that one of the goals of surgery for the treatment of incontinence is to restore the bladder and urethra to their normal position. The authors then describe the surgical techniques that might be used for incontinence, including the abdominal bladder suspension, the laparoscopic bladder suspension (Burch procedure), the sling procedure, the tension free vaginal tape (TVT) procedure, an anterior repair (cystocele repair), vaginal bladder suspension, collagen injections for intrinsic sphincter deficiency (ISD), the use of an artificial urinary sphincter, and Interstim (a surgically implanted electrical stimulation device). The authors describe the indications for each procedure and the anticipated recovery period. The authors conclude with a brief discussion of the indications for repeat operations. The chapter includes a number of case examples using these different strategies. Chapter references are located at the end of the book. 4 figures. 6 references.

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Building Support for Your Pelvic Floor. Mayo Clinic Women's Healthsource. 5(3): 4-5. March 2001.

The pelvic floor, including pelvic floor muscles, ligaments and other structures that support the uterus, bladder, vagina, and rectal area, often changes after pregnancy. This article discusses conditions that women may experience (called 'pelvic relaxation disorders') and strategies to rebuild the pelvic floor to help prevent future complications. The disorders include cystocele, a protrusion of the bladder behind the wall of the vagina; rectocele, a protrusion of the rectum that bulges into the vagina; enterocele, when the small intestine bulges into the top and upper back portion of the vaginal wall; and uterine prolapse, when the pelvic muscles and ligaments are stretched or weakened and the uterus descends partway or all of the way into the vaginal canal. Pregnancy is not the only cause of these conditions; normal aging, including diminishing levels of the female hormone estrogen, can also be a cause. Other risk factors include being overweight, repeated heavy lifting, or straining with bowel movements. Diagnosis can include patient history, physical exam, a defecating proctogram (x ray monitoring of defecation), and dynamic magnetic resonance imaging (MRI). Treatments can include Kegel exercise (to strengthen the pelvic floor muscles), reducing the strain on pelvic organs, a vaginal pessary to hold the uterus in place, and surgical repairs. Surgery must be individually tailored, taking into consideration all the pelvic organs that may be affected. One sidebar explains how to do Kegel exercises. 2 figures.

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Pubovaginal Sling Surgery for Simple Stress Urinary Incontinence: Analysis by an Outcome Score. Journal of Urology. 165(5): 1597-1600. May 2001.

This article reports on a study that assessed the results of pubovaginal sling surgery in women with simple stress urinary incontinence (SUI) using strict subjective and objective criteria. Simple incontinence was defined as sphincteric (bladder opening) incontinence with no concomitant urge incontinence, pipe stem or fixed scarred urethra, urethral or vesicovaginal fistula, urethral diverticulum, grade 3 or 4 cystocele, or neurogenic bladder. A total of 67 consecutive women (mean age 56 years plus or minus 11 years) who underwent pubovaginal sling surgery for simple sphincteric incontinence were prospectively followed for 12 to 50 months. Cure was defined as no urinary loss due to urge or stress incontinence, as documented by 24 hour diary and pad test, with the patient considering herself cured. Failure was defined as poor objective results with the patient considering surgery to have failed. Of the 67 patients, 46 (69 percent) had type II and 21 (31 percent) had type III incontinence. Preoperative diary and pad tests revealed a mean of 5.9 (plus or minus 3.6) stress incontinence episodes and a mean urinary loss of 91.8 grams (plus or minus 81.9 grams) per 24 hours. There were no major intraoperative, perioperative, or postoperative complications. Two patients (3 percent) had persistent minimal stress incontinence and 7 (10 percent) had new onset urge incontinence within 1 year after surgery. Overall using the strict criteria of the outcome score, 67 percent of the cases were classified as cured, and the remaining 33 percent were classified as improved. The degree of improvement was defined as a good, fair, and poor response in 21 percent, 9 percent, and 3 percent, respectively. Midterm outcome results defined by strict subjective and objective criteria confirm that the pubovaginal sling is highly effective and safe surgery for simple sphincteric incontinence. A followup of more than 5 years is required to establish the long term durability of this procedure. 2 tables. 11 references.

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How to Use a Pessary. American Family Physician. 61(9): 2729. May 1, 2000.

This patient education handout explains the use of the pessary, a plastic device that fits into the vagina to help support a woman's uterus, vagina, bladder, or rectum. Although many physicians are unfamiliar with the pessary, it remains an effective tool in the management of a number of gynecologic problems. The handout reviews the practical use of the pessary, which is most commonly used in the management of prolapse of the uterus (in which the uterus droops or falls down into the vagina), for pelvic support defects such as cystocele and rectocele, and in the treatment of stress urinary incontinence (SUI). There are a number of different types of pessaries and the physician will choose the most appropriate type. Followup care will include an immediate postplacement visit to the physician (a few days after the pessary is placed) and then a checkup every few months. Most pessaries can be worn for many days to weeks at a time before they have to be taken out and cleaned with ordinary soap and water. The pessary can fall out of the vagina if the woman strains or lifts something; if this happens regularly, the pessary is most likely too small and the woman should be refitted. Complications can be minimized with simple vaginal hygiene and regular followup visits. Patients are encouraged to contact their physicians if they experience any discomfort with the pessary or experience any trouble urinating or having a bowel movement.

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Practical Use of the Pessary. American Family Physician. 61(9): 2719-2726. May 1, 2000.

Although many physicians are unfamiliar with the pessary, it remains an effective tool in the management of a number of gynecologic problems. The article reviews the practical use of the pessary, which is most commonly used in the management of pelvic support defects such as cystocele and rectocele. Pessaries can also be used in the treatment of stress urinary incontinence (SUI). Good candidates for a pessary trial might include a pregnant patient, an elderly woman in whom surgery would be risky, and a woman whose previous operation for stress incontinence failed. The wide variety of pessary styles may cause confusion for physicians during the initial selection of the pessary. However, an understanding of the different styles and their uses will enable physicians to make an appropriate choice. The authors review each type and note their uses; one illustration depicts most of the types in current use. Complications can be minimized with simple vaginal hygiene and regular followup visits. The authors conclude that incorporating the use of the pessary into a physician's practice requires minimal investment; however, it may significantly improve the lifestyle of patients who have limited therapeutic alternatives. 8 figures. 2 tables. 11 references.

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