title: The predictive value of a cystocele for concomitant vaginal apical prolapse.
abstract: OBJECTIVE
  Recent studies showing a correlation between descent of the anterior and apical vaginal compartments suggest that cystoceles may recur if associated apical prolapse is not corrected. However, to date the anatomical relationship of apical prolapse with respect to cystocele has been incompletely reported. We present the predictive value of a cystocele for clinically significant vaginal apical prolapse.
  
  
  METHODS
  We retrospectively reviewed the records of all new patient visits to a urogynecology clinic in a 30-month period. Women with a point Ba value of -1 or greater (stage 2 cystocele and above) were included in analysis. Predictive values of clinically significant apical prolapse, defined as point C -3 or greater, were calculated and stratified by cystocele stage.
  
  
  RESULTS
  A total of 385 women were included in study. Point Ba was the leading edge of prolapse in 83.9% of cases. The position of Ba strongly correlated with that of the vaginal apex (Spearman ρ = 0.769, p <0.001). Overall 59.7% of patients had a point C of -3 or greater. The finding of clinically significant apical prolapse increased significantly with increasing Ba values. Of patients with stage 2, 3 and 4 cystocele point C was -3 or greater in 42%, 85% and 100%, respectively.
  
  
  CONCLUSIONS
  The finding of stage 2 or greater cystocele is highly suggestive of clinically significant apical vaginal descent to -3 or greater. Furthermore, as cystocele stage increases, the predictive value of apical prolapse also increases. Surgeons contemplating cystocele repair should have high suspicion for vaginal apical prolapse and consider concomitant repair.
authors.affiliation: Urology Department, School of Medicine, Stanford University, Stanford, California 94305-2200, USA. chrsuz@aol.com
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Elliott
authors.forename: Judy
authors.initials: J
authors.lastname: Yeh
authors.forename: Craig V
authors.initials: CV
authors.lastname: Comiter
authors.forename: Bertha
authors.initials: B
authors.lastname: Chen
authors.forename: Eric R
authors.initials: ER
authors.lastname: Sokol
mesh_terms: D000368:Aged; D052858:Cystocele / Q000150:complications / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D014596:Uterine Prolapse / Q000150:complications / Q000175:diagnosis*