Etiology, staging, and management of cystocele

A cystocele is usually found to protrude the urinary bladder through the vaginal wall. Various causes have been reported in the literature for the pathogenesis and development of cystocele. These can cumulatively lead to a remarkable weakness in the muscular and connective tissue layers related to the urinary bladder and anterior vaginal wall. The present study discusses the etiology, staging, and management of patients with cystocele. Evidence indicates that a defect within the pelvic-floor supporting system can significantly lead to the development of cystocele. Parity, increasing age, and obesity are the main associated risk factors for developing these events. Staging is important to decide the most suitable treatment plan, which might be conservative or surgical. Some patients do not require any management approach, being asymptomatic, and refuse the current treatment modalities. Surgery has been associated with enhanced outcomes and can be conducted via two different approaches, including anterior colporrhaphy and sacral colpopexy.

Leiomyoma of the anterior vaginal wall: a rare case

Background: Leiomyoma is a benign smooth muscle mesenchymal tumor, usually of uterine origin but may rarelydevelop in the vaginal walls. Case presentation: A case of 40-year-old para 5+0 woman with anterior vaginal wall leiomyoma is reported. Thepresentation mimics that of uterovaginal prolapse and hence presents a diagnostic challenge. The unusualappearance of the protrusion, failure to reduce at any time even while lying down, and complete absence of urinarysymptoms raised the suspicion of a rare case. The diagnosis was made through examination under anesthesia,cystoscopy, and biopsy. Histological examination of the biopsy specimen confirmed vaginal wall leiomyoma. Thepatient had complete excision of the mass without any complications. Discussion and Conclusion: Vaginal wall leiomyoma is a rare benign vaginal lesion that can easily bemisdiagnosed. Diagnosis involves critical clinical evaluation, especially during pelvic examinations. Any vaginalprotrusion should be approached with a high index of suspicion, especially in patients of reproductive age.

Influence of Toileting Behaviour on Anterior Vaginal Wall Prolapse Natural Course

Background: Many risk factors have been proposed for POP, and the cause seems most plausible to be multifactorial. This study aimed to investigate the effect of toileting behaviors on the anterior vaginal wall prolapse (AVWP) natural course.Methods: The data of 75 women who had been operated for symptomatic AVWP were recorded. The patients with grade ³II AVWP were included in this study, and they were divided into two groups according to voiding and defecation position. The volunteers who were voiding in the sitting position defined as Group 1, and Group 2 included the volunteers who were voiding in squatting position. The Colo-Rectal-Anal Impact Questionnaire (CRAIQ), Pelvic Floor Impact Questionnaire (PFIQ), Pelvic Organ Prolapse Impact Questionnaire (POPIQ), Urinary Impact Questionnaire (UIQ) and visual analog pain scores were used for evaluation of patients’ symptoms. Results: 44 patients enrolled in group 1 (sitting position) and 31 patients enrolled in group 2 (squatting position). BMI, number of parity, menopause duration, topical estrogen using, comorbidities, presence of constipation and urinary incontinence, and ped count for incontinence were similar in both groups. The time from initial symptoms to surgery was demonstrated shorter in group 2, 12 (3-73) and 24 (2-182) months, respectively (p=0.001). The PFIQ and POPIQ scores and the POP-related VAS score were statistically higher in patients who were voiding and defecating in squatting positions. Conclusion: Questioning the toileting position of patients with AVWP may be effective on the treatment option of the patient and may be beneficial on symptom control.

Atypical vaginal location of endometriosis following repeated urogynaecological surgery

We outline a case of vaginal endometriosis in scar tissue located in the distal part of the anterior vaginal wall close to the urethra following repeated urogynaecological surgery. Our case presents a 45-year-old woman diagnosed with pelvic endometriosis in her youth. She underwent several vaginal surgeries due to pelvic organ prolapse, symptoms of stress incontinence and decreased urinary flow. One year after her most recent vaginal surgery, she developed a tender lump in the lower part of the anterior vaginal wall. A urethral diverticulum was suspected, but a diagnostic puncture and biopsy unexpectedly showed histologically verified endometriosis. As the cyst recurred, surgical excision of all visible endometriosis tissue was performed. After 3 years of follow-up, the patient remained without recurrence. This case illustrates the risk of atypical implantation of endometriosis related to repeated urogynaecological surgery and that treatment requires surgery with thorough removal of all visible tissues.