In urethrocystocele, the anterior wall of the vagina recedes, allowing the urinary bladder and urinary tract, which lies ventral to it, to slide down with it. The phenomenon is often due to weakness of the retaining apparatus in the pelvic floor. When men are affected by the sliding down of the bladder and urinary tract, a hernia is usually present.
What is a urethrocystocele?
In a prolapse, a specific organ shifts from its physiological position. Prolapse can affect a wide variety of organs and is based on an extremely variable spectrum of causes, each depending on the organ involved. Cystocele is present in prolapse of the urinary bladder. In this phenomenon, the bladder shifts into a so-called hernia sac. If the urethra is affected in addition to the bladder, it is called urethrocystocele. Every prolapse is a pathological phenomenon. Urethrocystocele almost exclusively affects women. The vaginal wall plays a causative role in this context. Both the urinary bladder and the urinary tract are anatomically located ventral to the vagina. If the anterior vaginal wall slips lower, this can result in prolapse of the urinary bladder and urinary tract in the sense of a urethrocystocele. In most cases, the result is incontinence of the bladder. Clinically, urethrocystocele is often described as cystocele with urethrocele, with prolapse of the anterior vaginal wall usually given as the cause.
Causes
The cause of urethrocystocele is prolapse of the anterior vaginal wall, which manifests as weakness of the retaining apparatus. In most cases, patients are women whose urinary bladder and urinary tract lie everted into the anterior vaginal wall. In some patients, the prolapse of the bladder and urinary tract is so significant that the organs are visible at the vaginal entrance or slip even further forward. In most cases, urethrocystocele is the secondary event of uterine or vaginal prolapse. This event is usually due to weakness of the muscles in the lesser pelvis. Weakness of the ligamentous apparatus and the levator ani or diaphragma urogenitale muscle in the pelvic floor may also play a causative role. The holding devices of the organs can become insufficient, for example, in the context of a weakness of the connective tissue, after physical overexertion, due to overweight or multiple vaginal births. In this context, first of all a descensus occurs, which causes the organs to sag. The phenomenon of urethrocystocele may develop from this descensus. If the patient is a man, the phenomenon is usually causally related to thigh hernias or inguinal hernias. In this case, it is a hernia in which the organs are invaginated.
Symptoms, complaints and signs
In the early phase of a urethrocystocele, the patient’s urinary bladder and urinary tract descend from their physiological position in a ventral direction. Only in rare cases does this phenomenon cause pain or other discomfort even in the early phase. As it progresses, symptoms such as pain during sexual intercourse present themselves. In addition, the function of the urinary bladder may be disturbed, causing micturition disorders. Patients also frequently suffer from recurrent urinary tract infections. However, bladder emptying disorders are the leading symptom and can manifest themselves, for example, in urinary retention or in frequent urination with reduced urine volume. In the late stage, urinary incontinence is often present. Most patients remain asymptomatic even in the late stage of the phenomenon, noticing the prolapse of the organs at most in extreme cases in which the organs slide to the vaginal entrance.
Diagnosis and course of the disease
Above all, the diagnosis of cystocele of the bladder can be made by simple palpation. In the phenomenon, a more or less distinct protrusion can be palpated on the anterior wall of the vagina, which is usually sufficient to make the diagnosis. When patients are asked to push, the protrusion descends in depth and becomes even more prominent. In most cases, the suspicion of urethrocystocele is confirmed by ultrasound. The prognosis is considered excellent.
Complications
In urethrocystocele, the affected person primarily suffers from severe pain. This can also occur at night and in the form of pain at rest, thus having a very negative effect on the patient’s daily life.Often the pain spreads to the neighboring regions of the body and can cause severe discomfort there as well. Especially during sexual intercourse the pain occurs, so that it can also lead to tension with one’s partner. Furthermore, urination is also frequently associated with pain. Those affected also frequently suffer from infections of the urinary tract. Furthermore, incontinence occurs, which also has a negative effect on the patient’s everyday life. Due to the symptoms of urethrocystocele, many patients also suffer from psychological complaints or depression. Some sufferers are also ashamed of the discomfort. The treatment of urethrocystocele strongly depends on its cause. In some cases, the discomfort can be solved by various trainings or with the help of medications. In severe cases, surgical interventions are necessary. Special complications usually do not occur. Furthermore, in most cases, urethrocystocele does not negatively affect the life expectancy of the patient
When should you see a doctor?
The affected person is usually always dependent on medical treatment and examination in the case of a urethrocystocele, since this condition cannot heal on its own. The earlier a doctor is consulted, the better the further course of this disease usually is. Therefore, it is highly recommended to contact a doctor at the first symptoms and signs of this disease. A doctor should be consulted if the affected person suffers from severe pain during sexual intercourse. This pain can also spread to the abdomen. Furthermore, disorders during urination or very frequent urinary tract infections also indicate this disease and must be examined by a doctor if they occur over a long period of time and without a particular reason. Those affected have to urinate frequently and not infrequently suffer from psychological upsets as a result. The 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 and therapy
Therapy for a urethrocystocele involves returning the organs to their physiologically natural position. This procedure requires surgical intervention in most cases. Depending on the cause, further treatment may also need to take place. In women, this further treatment usually involves training of the postural apparatus, such as stabilizing pelvic floor training. In men, an inguinal hernia, which 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 similar to the treatment of direct hernias. The opening of a direct hernia is closed surgically. Indirect hernias depend on the physician to leave an opening for the spermatic cord. In principle, the procedures of both operations go back to the Italian Bassini.
Prevention
Urethrocystocele can be prevented to some extent. Women can attend preventive pelvic floor training, for example. Via the training sessions, they strengthen their pelvic floor muscles, which play an important role in the holding apparatus of the urinary bladder and urinary tract. The organs are stabilized in their anatomical position and the probability of ventral slippage is reduced. The same preventive measures apply to men with regard to urethrocystocele as to inguinal hernias and hernias of the thigh.
Follow-up
After successful treatment of a urethrocystocele, intensive follow-up care should always take place, as only through this can secondary diseases that arise and the recurrence of a urethrocystocele be detected and treated in time. Follow-up treatment consists of regular gynecological and, if urinary incontinence has occurred, urological examinations. This should include imaging (CT, ultrasound, cystography), as this is the only way to reliably detect a recurrent urethrocystocele, especially in early stages. If there is permanent urinary incontinence, this must be treated urologically.Scarring in the mucosa of the vagina resulting from the treatment of urethrocystocele should be treated gynecologically. If problems with sexual intercourse result from the treatment, this should also be discussed with the treating gynecologist, who can recommend certain countermeasures and/or prescribe special medications and ointments. If permanent infertility has resulted as a consequence of the treatment of the urethrocystocele, this must also be treated gynecologically, if possible. Since sexual infertility, like permanent urinary incontinence, can also result in massive social and psychological problems, additional psychotherapeutic support may be necessary and helpful. In particular, if depression develops as a late consequence of the disease, it must be treated psychotherapeutically but also psychiatrically (medically). Behavioral therapy may additionally help in the case of sexual restrictions and should therefore be considered.
What you can do yourself
A urethrocystocele is usually treated with surgery and medication. After surgery, 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 dizziness or other signs of internal bleeding suddenly appear. After surgery, patients should stay at home for at least two to four weeks. Physical activity can contribute to a faster recovery in the later course. Initially, the most important measure is to keep the body hydrated, provide important nutrients, and get plenty of sleep. These measures are usually sufficient to optimally support the conservative therapy. Should severe symptoms occur, a hospital must be visited. It is also necessary to do this again at the end of the treatment. The doctor will examine the vaginal wall and, if necessary, the urethra and urinary bladder again in detail. If urinary incontinence has already occurred, adult diapers or panty liners must continue to be worn and the pelvic floor must be specifically strengthened through pelvic floor training.
