The urinary bladder, that is, the bladder, is adjacent to the anterior wall of the vagina, so it is frequently affected by vaginal area defects and infections. Cystocele is herniation of the urinary bladder outward and downward from the anterior vaginal wall. It is seen in the vaginal opening as a palpable mass from the front downwards.
What Does Cystocele Mean?
Cystocele is the name of the structure that looks like a sac formed by the bladder hanging from the vaginal wall. As the bladder protrudes into the vaginal area, it protrudes from the vaginal wall as a convex sac. If there is a defect in the side walls, which we call the paravaginal area, and sagging occurs, the mass that can be felt from below becomes larger and larger.
Why Does Cystocele Cause?
Cystocele can usually be due to trauma caused by normal vaginal delivery. Even if the method of delivery was not vaginally; It is enough to carry the fetus and to suffer some pain. In some deliveries, bladder and bladder hole (urethra) tears occur as the baby leaves the vaginal area. These tears and incisions that occur during childbirth are of vital importance.
If not repaired, it results in severe infection and painful urination. Traumas that cause cystocele usually occur as a result of rupture or damage to the bladder suspensory ligaments and cannot be repaired during delivery.
The degree of sagging cystocele increases with intra-abdominal pressure and chronic cough, and heavy lifting after normal vaginal delivery. In addition, bladder sagging; It also develops due to unrepaired rectocele. Since the posterior wall of the vagina is weak, it will try to control the intra-abdominal pressure, the anterior wall of the vagina, that is, the bladder area, and if rectocele is not operated, it will cause cystocele.
What are the Symptoms of Cystocele? >Urinary incontinence
Inability to urinate if the degree of cystocele is high, urinating by straining or urinating from the vaginal area after the patient's hand has placed the bladder in place
Vaginal discharge and odor
Pain in the vaginal area
In the pelvic region and blood Pain in the abdomen
Recurring urinary tract infection and being resistant to treatment (due to accumulating urine)
Urine during sexual intercourse incontinence
Decreased sexual pleasure and lack of self-confidence
Inability to orgasm due to the deletion of vaginal folds on the anterior vaginal wall (vaginal rugae)
Cystocele (urinary bladder prolapse surgery) eliminates these complaints.
Cystocele Grades
Urinary bladder sagging has been graded for use both clinically and surgically.
When the patient is at rest in stage 1 cystocele, the palpable mass in the vaginal region does not come out, 1-2 cm in stage 2, over 2 cm in stage 3, stage 1 cystocele In stage 4, the bladder is completely located outside the vagina even when resting.
While patients with stage 4 cystocele have difficulty urinating, inability to urinate by pushing or manually replacing the bladder, urinary incontinence may be present in patients with stage 1, involuntary urination. .
If patients also have urinary incontinence, they should be evaluated urogynecologically, urinary incontinence examination should be performed and the necessary surgical planning should be considered as a whole.
Diagnosis of Cystocele Urinary Bladder Prolapse
When patients with cystocele (urinary bladder prolapse) apply to the clinic, the diagnosis is made by general gynecological examination. However, it should be questioned whether the patient has simultaneous urinary incontinence, incontinence during sexual intercourse or physical activity, the diagnosis should be made and the necessary surgical planning should be considered as a whole for both cystocele and urinary incontinence.
How to Treat Urinary Bladder Prolapse?
Prolapse of the urinary bladder can be treated surgically. However, in a very small group of patients, if the bladder prolapse is in stage 1 or still in its infancy, the muscle and connective tissue can be supported by applying a vaginal cautery. With kegel exercises to be done afterward, the cystocele at a very early stage can be intervened with laser without surgery.
How is Cystocele Surgery Performed?
Cystocele surgery is performed in patients with stage 2 and above cystocele. Vaginal laser can be tried in stage 1 patients, but as weight gain and heavy lifting continue, cystitis may occur. The hand will increase in stage-2 and above, and surgery will be required.
The urinary bladder surgery (cystocele) is performed in the form of repairing the hernia sac in which the urinary bladder is located and suturing the anterior wall of the vagina again. Processing time is about 1 hour. It can be done with general anesthesia and spinal anesthesia. However, general anesthesia is preferred as bladder functions will also be controlled for the first 12 hours after cystocele surgery.
When Should Cystocele Surgery Be Performed?
If urinary bladder prolapse is stage 2 and above, surgery should definitely be planned. In patients with stage 1, that is, patients with very little cystocele, the cystocele grade will increase over the years, secondary to the decrease in collagen due to gravity, weight, chronic cough and menopause, and surgery will be required. difficult urination; Since the urethra (urinary bag hole) ligaments are ruptured with the prolapsed bladder, serious urinary problems will also occur, so cystocele should be treated when first diagnosed.
What Happens If Cystocele Is Not Operated?
If cystocele is not operated Urinary bladder sagging may increase considerably due to the ongoing pressure and gravity effect. The urinary bladder hole, that is, the dysfunction of the urethra, and a serious decrease in sexual pleasure can cause problems such as urinary incontinence during intercourse.
If cystocele disease is not treated surgically, it can lead to serious consequences that impair the quality of functional life and sexual life.
If cystocele is not treated surgically.
p>Risks of Urinary Bladder Prolapse Surgery
The tissue between the vagina and bladder in cystocele surgery is very thin. While the anterior vaginal wall is being opened for cystocele surgery; Care should be taken to avoid bladder injury. In addition, if there is an active urinary tract infection, surgery should be treated as it will increase the infection.
Since the tissue healing is slow after menopause, the vaginal structure is thin, supportive treatments, creams or vaginal laser can be applied before and after the surgery. If the tissue is too thin, an incision may be made in the anterior wall of the vagina.
Cystocele ame The 2 risks of the infection are bladder rupture (during surgery) and cystovaginal fistula (formation of a channel between the vagina and the bladder). In order to avoid both complications, the need for tissue support, cream and laser should be evaluated in the preoperative evaluation, and deep incisions should be avoided at the time of surgery.
In the presence of cystovaginal fistula, continuous vaginal urine is seen and the diagnosis is made by methylene blue examination; The treatment is planned surgery.
Healing After Cystocele Surgery
Returning to normal life after cystocele surgery is the 3rd day. The hospital stay is at least 12 hours. The shower can be taken standing up the next day. After the surgery, the first urine should be made in the hospital and discharged home. Wearing tight clothes should be avoided for the first 10 days after cystocele surgery and swimming should not be done.
Sexual intercourse and heavy sports activities can be done in the 4th week. There is no harm in doing light sports activities at the end of the first week. It is useful to remember to empty the bladder every 3-4 hours in the first week.
A full recovery is experienced 3-4 weeks after the bladder prolapse surgery.
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