Barbaros Mah. Ağaoğlu My Prestige, Kat: 15 Daire: 127 Ataşehir İstanbul
The bladder, or the urinary bladder, is in close proximity to the vaginal anterior wall, which means it is frequently affected by vaginal defects and infections. Cystocele refers to the bladder bulging out and down through the vaginal front wall. It is typically seen as a bulging mass in the vaginal opening.
Cystocele is the term used to describe the bulging of the bladder through the vaginal wall. When the bladder drops into the vaginal space, it protrudes in a bulging sac-like shape. If there is a defect in the paravaginal area (the lateral walls),the mass that is felt from below becomes larger and wider.
Cystocele is usually caused by trauma during normal vaginal childbirth. Even if the delivery was not vaginal, carrying the fetus and experiencing some pain is sufficient. In some births, tears in the bladder and urinary tract (urethra) can occur as the baby passes through the vaginal area. These tears and lacerations during childbirth are of significant importance.
If these tears are not repaired, they can result in serious infections and painful urination. The trauma that leads to cystocele generally occurs due to the rupture or damage to the bladder-supporting ligaments, and it cannot be repaired during childbirth.
After normal vaginal birth, increased intra-abdominal pressure, chronic coughing, and heavy lifting can worsen the degree of cystocele. Additionally, bladder prolapse can develop due to uncorrected rectocele. Since the back wall of the vagina is weak, the anterior vaginal wall (bladder area) tries to control the abdominal pressure, which leads to cystocele if rectocele is not repaired.
In women who have not had children, connective tissue diseases, being overweight, smoking, and chronic coughing can also contribute to cystocele.
Cystocele surgery addresses these complaints.
Bladder prolapse is classified both clinically and surgically for treatment purposes.
In stage 4 cystocele, patients may experience difficulty urinating or be unable to urinate without manually repositioning the bladder, while patients in stage 1 may only experience urinary incontinence.
If urinary incontinence is also present, a urogynaecological evaluation should be performed, and the necessary surgical planning for both cystocele and urinary incontinence should be considered together.
Patients with cystocele are diagnosed through a general gynecological examination. It is important to also assess whether the patient has concurrent urinary incontinence, whether they experience leakage during sexual activity or physical exercise, and to ensure the diagnosis is made appropriately. Surgical planning for both cystocele and urinary incontinence should be done as a whole.
Bladder prolapse is treated surgically. However, in a small group of patients, if the bladder prolapse is at stage 1 or in its early stages, vaginal tightening procedures may be performed to support the muscles and connective tissue. Kegel exercises can help treat early cystocele without the need for surgery, and laser interventions can also be considered.
Cystocele surgery is recommended for patients in stage 2 or higher. In stage 1 patients, vaginal laser treatment may be considered, but if obesity or heavy lifting continues, the cystocele may progress to stage 2 or higher, requiring surgical intervention.
Bladder prolapse surgery (cystocele surgery) involves repairing the hernia containing the bladder and repositioning the vaginal front wall. The procedure takes about one hour and can be performed under general or spinal anesthesia. However, general anesthesia is preferred, as bladder function needs to be monitored during the first 12 hours after surgery.
The costs of cystocele surgery vary depending on whether urinary incontinence is present, whether additional procedures such as labiaplasty or vaginoplasty are required, and the choice of hospital or clinic.
If bladder prolapse is at stage 2 or higher, surgery should definitely be planned. In stage 1 patients, cystocele may worsen over time due to gravity, weight gain, chronic coughing, and collagen depletion due to menopause, requiring surgery eventually.
When bladder prolapse progresses, urinary incontinence or difficulty urinating may occur due to the rupture of the urethral ligaments with the prolapsed bladder, causing severe urinary issues. Therefore, cystocele should be treated as soon as it is diagnosed.
If cystocele is not treated surgically, the continued pressure and gravity effects will cause the bladder prolapse to worsen.
This can lead to difficulty urinating, severe urinary tract infections, vaginal infections, persistent unpleasant odors, urinary incontinence, bladder perforation, loss of urethral function, and decreased sexual pleasure, among other issues.
If left untreated, cystocele can lead to serious functional and sexual quality of life issues.
In cystocele surgery, the tissue between the vagina and bladder is very thin. While opening the vaginal front wall for surgery, care must be taken to avoid bladder injury. If an active urinary tract infection is present, it should be treated beforehand to reduce the risk of surgical infection.
After menopause, tissue healing is slower, and since the vaginal structure is thin, supportive treatments such as creams or vaginal lasers may be applied before and after surgery. If the tissue is very thin, an incision in the vaginal front wall may occur.
The two main risks of cystocele surgery are bladder rupture (during surgery) and the formation of a vesicovaginal fistula (a channel between the bladder and vagina). To avoid these complications, tissue support should be assessed preoperatively, and deep cuts should be avoided during surgery.
If a vesicovaginal fistula occurs, continuous vaginal urine leakage will be observed, and diagnosis is made via methylene blue examination. Treatment is planned through surgery.
The recovery time after cystocele surgery is about 3 days. The hospital stay is at least 12 hours, and the patient can take a shower the following day. The first urination should be done in the hospital before being discharged.
Since absorbable sutures are used during cystocele surgery, the stitches do not need to be removed. After surgery, tight clothing should be avoided for the first 10 days, and swimming should be avoided.
Sexual activity and intense physical exercises can be resumed after 4 weeks, while light physical activities can be started after the first week. It is advisable to empty the bladder every 3-4 hours during the first week.
Complete recovery typically occurs 3-4 weeks after bladder prolapse surgery.
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