The effects of severe cystocele on urogynecologic symptoms and findings.
BACKGROUND
To evaluate the effects of severe cystocele on lower urinary tract function.


METHODS
Urogynecologic evaluation composed of patient questionnaire, urinary diary, pad test, Q-tip test, perineal ultrasonography and cystometry was performed on 60 patients with reducible grade III or IV cystocele before and after reduction of the prolapsed organs. The data were analyzed by Paired-t and Chi-square tests and Pearson's correlation analysis.


RESULTS
One-hour pad test revealed that 17 (28.3%) of the 60 patients with reducible severe cystocele had no demonstrable urinary incontinence, while 26 (43.3%) had mild and 17 (28.3%) had moderate or severe incontinence. However, all patients had moderate or severe incontinence after reduction with vaginal packing (p<0.001). The vaginal packing had no significant effect on the maximum bladder capacity, the intravesical pressure at maximum capacity and the frequency of detrusor instability (33.3%). Whereas, urine loss after 1-hour pad test, bladder neck mobility, straining Q-tip angle and PUVA increased significantly after reduction of the cystocele (p<0.01).


CONCLUSIONS
As grade III or IV cystocele may mask the presence and severity of urinary stress incontinence, preoperative urogynecological evaluation should be done after reduction of the cystocele.
Yalcin
O T
OT
Osmangazi University School of Medicine, Department of Gynecology and Obstetrics, Unit of Urogynecology, Eskisehir, Turkey.
Yildirim
A
A
Hassa
H
H
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003950:Diagnostic Techniques, Urological; D005260:Female; D006801:Humans; D008875:Middle Aged; D010570:Pessaries; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D014463:Ultrasonography; D001745:Urinary Bladder Diseases / Q000000981:diagnostic imaging / Q000473:pathology*; D014550:Urinary Incontinence, Stress / Q000000981:diagnostic imaging / Q000473:pathology*