A CYSTOCELE MAY COMPENSATE FOR LATENT STRESS-INCONTINENCE BY STRETCHING THE VAGINAL HAMMOCK

Aims: To examine why anatomical correction of a cystocele may cause st ress incontinence in a patient with no prior history of this condition . Methods: The study group consisted of 5 patients, aged 45-63 years, with stress incontinence induced by supporting a cystocele with a pess ary. The patients were otherwise continent. Testing was performed in a semirecumbent sitting position under perineal ultrasound control. The patients were asked to strain and cough before and after supporting t he bladder neck with both sponge-holding forceps and a ring pessary, R esults: In all 5 patients, urine loss on stress was noted with bladder base support by forceps and pessary insertion. With both, asymmetrica l downward stretching of the vagina and bladder base was observed. Whe n the cystocele was allowed to balloon outwards, the asymmetrical patt ern converted to a symmetrical 'funnelling' of the anterior and poster ior walls of bladder neck. Conclusion: This study appears to support t he hypothesis that, in addition to urethral narrowing, a ballooning cy stocele may restore urethral closure by removing laxity from the vagin al hammock. Correction of a cystocele may cause incontinence by removi ng a fortuitous, but abnormal compensatory mechanism.