The effects of severe cystocele on urogynecologic symptoms and findings

Background. To evaluate the effects of severe cystocele on lower urinary tr act function. Methods. Urogynecologic evaluation composed of patient questionnaire, urina ry diary, pad test, Q-tip test, perineal ultrasonography and cystometry was performed on 60 patients with reducible grade III or IV cystocele before a nd after reduction of the prolapsed organs. The data were analyzed by Paire d-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. Ho wever, all patients had moderate or severe incontinence after reduction wit h vaginal packing (p <0.001). The vaginal packing had no significant effect on the maximum bladder capacity, the intravesical pressure at maximum capa city and the frequency of detrusor instability (33.3%). Whereas, urine loss after 1-hour pad test, bladder neck mobility, straining Q-tip angle and PU VA increased significantly after reduction of the cystocele (p <0.01). Conclusions. As grade III or IV cystocele may mask the presence and severit y of urinary stress incontinence, preoperative urogynecological evaluation should be done after reduction of the cystocele.