Urethrocystocele

Urethrocystocele

In the case of urethrocystocele, the front wall of the vagina lowers and allows the bladder and the urinary tract lying ventral to slide downwards. The phenomenon is often due to a weakness of the holding apparatus in the pelvic floor. When men are affected by slippage of the bladder and urinary tract, there is usually a hernia.

What is a urethrocystocele?

In a prolapse, a specific organ shifts from its physiological position. The prolapse can affect a wide variety of organs and is based on an extremely variable spectrum of causes, each depending on the organ affected. A cystocele occurs when the urinary bladder prolapses. With this phenomenon, the bladder shifts into a so-called hernial sac. If the urethra is also affected in addition to the bladder, this is referred to as a urethrocystocele. For lateral midface fracture explained, please visit psyknowhow.com.

Any prolapse is a pathological phenomenon. A urethrocystocele affects almost exclusively women. The vaginal wall plays a causal role in this context. Both the bladder and the urinary tract are located anatomically anterior to the vagina. If the anterior vaginal wall slips lower, this can result in a prolapse of the bladder and urinary tract in the sense of a urethrocystocele.

In most cases, the result is bladder incontinence. The urethrocystocele is often clinically described as a cystocele with urethrocele, with a prolapse of the anterior vaginal wall usually being given as the cause.

Causes

The cause of the urethrocystocele is a prolapse of the anterior vaginal wall, which manifests itself in a weakness of the supporting apparatus. In most cases, the patients are women whose bladder and urinary tract are invaginated in the front wall of the vagina. In some patients, the prolapse of the bladder and urinary tract is so significant that the organs at the vaginal entrance are visible or even protrude further.

In most cases, the urethrocystocele is secondary to a uterine or vaginal prolapse. This event is usually due to a weakness in the muscles in the small pelvis. A weakness of the ligaments and the levator ani muscle or urogenital diaphragm in the pelvic floor can also play a causal role. The holding devices of the organs can become insufficient, for example, as part of a weakness in the connective tissue, after physical exertion, as a result of being overweight or multiple vaginal births.

In this context, a descent initially occurs, which causes the organs to sink. The phenomenon of urethrocystocele can develop from this descent. If the patient is male, the phenomenon is usually causally related to femoral or inguinal hernias. In this case it is a fracture in which the organs invaginate.

Symptoms, Ailments & Signs

In the early phase of a urethrocystocele, the patient’s bladder and urinary tract descend from their physiological position in an anterior direction. Only in rare cases does this phenomenon cause pain or other symptoms in the early stages. Over time, symptoms such as pain during sexual intercourse appear.

In addition, the urinary bladder can be disturbed in its function and thus cause micturition disorders. Patients often also suffer from recurring urinary tract infections. However, bladder emptying disorders are the main symptom and can manifest themselves, for example, in urinary retention or in frequent urination with a reduced amount of urine.

In the late stage, urinary incontinence is common. Most of the patients remain asymptomatic even in the late stage of the phenomenon and only noticed the prolapse of the organs in extreme cases where the organs slip to the vaginal entrance.

Diagnosis & course of disease

Above all, the diagnosis of a cystocele of the bladder can be made by simple palpation. With this phenomenon, a more or less clear protrusion can be felt on the front wall of the vagina, which is usually sufficient for diagnosis. When patients are asked to push, the bulge sinks in depth and becomes even more prominent. In most cases, the suspicion of a urethrocystocele is confirmed by ultrasound. The prognosis is excellent.

Complications

In the case of urethrocystocele, those affected primarily suffer from severe pain. These can also occur at night and in the form of rest pain and thus have a very negative effect on the patient’s everyday life. The pain often spreads to the neighboring regions of the body and can also lead to severe discomfort there.

The pain occurs especially during sexual intercourse, so that tension with your partner can also arise. Furthermore, urination is often associated with pain. Those affected also often suffer from infections of the urinary tract. Incontinence continues to occur, which also has a negative effect on the patient’s everyday life.

Due to the symptoms of the urethrocystocele, many patients also suffer from psychological problems or depression. Some sufferers are also ashamed of the symptoms. The treatment of urethrocystocele depends very much on its cause.

In some cases, the symptoms can be solved with various types of training or with the help of medication. In severe cases, surgical interventions are necessary. Special complications usually do not arise. Furthermore, in most cases, the urethrocystocele does not have a negative effect on the patient’s life expectancy

When should you go to the doctor?

In the case of a urethrocystocele, the person affected is usually always dependent on medical treatment and examination, since this disease cannot heal on its own. The sooner a doctor is consulted, the better the further course of this disease. Therefore, it is highly recommended to contact a doctor at the very first symptoms and signs of this disease.

A doctor should be consulted if the person concerned suffers from severe pain during sexual intercourse. This pain can also spread to the abdomen. Furthermore, problems with urination or very frequent infections of the urinary tract indicate this disease and must be examined by a doctor if they occur over a longer period of time and without any particular reason.

Those affected often have to urinate and often suffer from mental disorders as a result. Urethrocystocele can be treated by a urologist. The further course depends very much on the time of diagnosis and the progress of the disease, so that no general prediction can be made.

Treatment & Therapy

When treating a urethrocystocele, the organs are returned to their physiologically natural position. This process requires surgical intervention in most cases. Depending on the cause, further treatment may also have to take place. For women, this further treatment corresponds in most cases to training of the holding apparatus, such as stabilizing pelvic floor training.

In men, an inguinal hernia that may be the cause must also be treated. This treatment takes place as part of the repositioning operation and, above all, ensures that the hernia cannot protrude in the future. In this case, the treatment of an indirect hernia is not the same as the treatment of direct hernias.

The opening of a direct hernia is surgically closed. Indirect hernias rely on the doctor leaving an opening for the spermatic cord. In principle, both operations go back in their procedure to the Italian Bassini.

Prevention

Urethrocystocele can be prevented to a certain extent. Women can, for example, attend pelvic floor exercises as a preventive measure. Through the training sessions, they strengthen their pelvic floor muscles, which play an important role in supporting the bladder and urinary tract. The organs are stabilized in their anatomical position and the probability of ventral slippage is reduced. For men, the same preventive measures apply to urethrocystocele as to inguinal and thigh hernias.

Aftercare

After the successful treatment of a urethrocystocele, intensive follow-up care should always take place, since this is the only way to identify and treat the secondary diseases that occur as a result, as well as the recurrence of a urethrocystocele. Follow-up treatment consists of regular gynecological and, if urinary incontinence has occurred, urological examinations.

Imaging (CT, ultrasound, cystography) should also be performed here, as this is the only way to reliably detect a new urethrocystocele, especially in the early stages. If there is persistent urinary incontinence, it must be treated urologically. Scarring in the vaginal mucosa caused by treatment of the urethrocystocele should be treated gynecologically.

If problems with sexual intercourse result from the treatment, this should also be discussed with the attending gynecologist, who can recommend certain countermeasures and/or prescribe special medication and ointments. If permanent infertility has developed as a result of the treatment of the urethrocystocele, this must also be treated gynecologically, if possible.

Since sexual infertility as well as permanent urinary incontinence can also result in massive social and psychological problems, psychotherapeutic support can also be necessary and helpful. In particular, if depression develops as a late consequence of the disease, it must be treated psychotherapeutically but also psychiatric (medicamentally). Behavior therapy can also help in the case of sexual restrictions and should therefore be considered.

You can do that yourself

A urethrocystocele is usually treated surgically and with medication. After an operation, the patient must take it easy and inform the doctor about any physical complaints. In case of severe pain, problems with urination or cramps, the doctor should be consulted. The same applies if you suddenly experience dizziness or other signs of internal bleeding.

After the surgical procedure, patients should stay at home for at least two to four weeks. Physical activity later on can help speed recovery. At the beginning, the most important measure is to provide the body with sufficient liquid and important nutrients and to sleep a lot. These measures are usually sufficient to optimally support conservative therapy.

If the symptoms become severe, a hospital must be visited. This is necessary again at the end of the treatment. The doctor will examine the vaginal wall and, if necessary, the urethra and bladder again. If urinary incontinence has already occurred, adult diapers or panty liners must continue to be worn and the pelvic floor must be strengthened through pelvic floor training.

Urethrocystocele