Does levator ani injury affect cystocele type?

Abstract

ABSTRACT

Diagnosis of cystocele type by clinical examination and pelvic floor ultrasound

“…The Green radiological classification of cystocele categorizes cystocele based on the degree of retrovesical angle on maximal Valsalva maneuver and rotation of the urethral axis6. This classification has long since fallen out of favor, together with cystourethrography, despite the fact that different types of cystocele are associated with different functional presentations and symptoms13. In this study we have shown that it is possible to distinguish these two types of cystocele by clinical examination, with moderate to good agreement between observers and with imaging findings.…”

“…Women with a Green type III cystocele tend to suffer more from voiding dysfunction than stress incontinence. The etiology of cystourethrocele is less likely to be caused by paravaginal defects than is the type III cystocele13.…”

“…avulsion injury, which is due to childbirth8, 9, associated with prolapse10 and prolapse recurrence11, 12. A Green type II cystocele is more commonly found in patients with stress incontinence and an intact levator13. Women with a Green type III cystocele tend to suffer more from voiding dysfunction than stress incontinence.…”

Prevalence of levator ani muscle injury in Chinese women after first delivery

“…Levator ani muscle injury has been identified as a risk factor for pelvic organ prolapse and urinary incontinence in women1–4, and is reported in 13–36% of Caucasian women after their first vaginal delivery5, 6. Instrumental delivery, especially forceps delivery, is associated with a higher risk7.…”

Ultrasound imaging of the pelvic floor: Where are we going?

“…More recent work on the measurement of the levator hiatus suggests that the non‐Euclidean nature of the hiatus highlights the possible error when deriving measurements in a single plane without fixed landmarks 59. A provocative analysis by Eisenberg et al60 proposes that the cystocele with an intact retrovesical angle could be associated with levator trauma and therefore be associated with childbirth events: confirmation of these observations is required.…”