Cystocele: The Daily PANCE Blueprint
Which of the following is the first-line management of a cystocele in a patient with minimal to no symptoms?
A. Estrogen therapy alone
B. Vaginal pessary
C. Anticholinergics
D. Anterior colporrhaphy
E. Bowel regimen
Answer and topic summary
The answer is B. Vaginal pessary
Pelvic organ prolapse is a common condition defined by herniation of the pelvic organs. A cystocele in particular a type of anterior prolapse defined by herniation of the anterior vaginal wall that leads to bladder “dropping.” Risk factors include age, obesity, and parity. Clinical features depend but may include vaginal pressure, low back/pelvic pain, issues with urination, and sexual dysfunction. Diagnosis is made through pelvic examination. Treatment is case-specific and depends on the patient and the severity of the prolapse. Conservative measures include vaginal pessary and pelvic floor muscle training. Surgery is indicated in those who don’t want to try conservative measures or those with symptomatic prolapse.
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