Modelized analysis of the effect of reduction of a cystocele by vaginal pack on voiding of women with grade IV cystocele.

Objectives: To evaluate the effect of reduction of a cystocele by vaginal p ack on the voiding of women with grade IV cystocele. Methods: Two successive pressure-flow analyses were performed in a series o f 21 patients: the first after insertion of a vaginal pack to reduce the cy stocele, and the second after removal of he pack. The VBN method was applie d to analyse uroflowmetries, allowing evaluation of two parameters for each uroflowmetry: one reflecting the urethra and the other reflecting the detr usor. Results: Only 14 patients were able to perform the 2 uroflowmetries in a si ngle stream with a volume greater than 100 ml. The vaginal pack improved th e urethral parameter in 10 patients, but had no effect in the other 4 patie nts; it did not alter detrusor function. The urethral parameter was improve d in patients whose obstruction was relieved according to the urodynamic cr iterion. Conclusions: Modelized analysis of pressure-flow analyses with and without a vaginal pack supports the conclusions of urodynamic tests concerning the preoperative status of patients with high grade cystocele by identifying th ose patients in whom the cystocele affects bladder emptying.