Urogenital ImagingCystocoele, bladder
a
protrusion of the bladder into the anterior vagina. The condition is the result of weakening of the support structures of the bladder base, and is typically seen in multiparous middle-aged women. The condition may be asymptomatic or cause stress incontinence, frequency and a predisposition to infection. Symptoms are more likely when there is a co-existent urethrocoele (see
urethrocoele).
Urodynamic studies are the most helpful diagnostic study in the evaluation of a patient with stress incontinence, although cystourethrography may also be a useful adjunct. Films are obtained in the lateral postion while the patient is resting and repeated when the patient is straining (Fig.1). The position of the urethra is indicated by a radiopaque catheter or by a chain with metallic beads introduced into the urethra (static chain cystourethrography). On straining, a cystocoele is evident as an abnormal descent of the bladder base, which may or may not be accompanied by an abnormal increase in the posterior vesicourethral angle. The bladder neck may be funnelled with stress-induced urinary leakage. Severe cases, where the abnormality is present at rest, may be recognized at CT or MRI (Fig.2).
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a. Lateral view of the pelvis during cystography, showing a contrast-filled bladder.
b. Repeat lateral view taken during straining shows protrusion of the bladder floor into the position of the vagina, confirming the presence of a cystocoele.
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Cystocoele, bladder, Fig.1 (a) | | Cystocoele, bladder, Fig.1 (b) | | Cystocoele, bladder, Fig.2 |