PANCE Blueprint Genitourinary (5%)

Patient will present as → a 45-year-old female complaining of pressure in the pelvis and vagina along with discomfort when straining. She also feels that her bladder hasn't fully emptied after urinating.

A bladder prolapse (cystocele) occurs when the supportive connective tissues separating the bladder and vagina weaken, leading to a prolapse of the bladder into the superior end of the vagina

This results in a bulge of the bladder into the vaginal wall (a bladder hernia) + urinary symptoms

This can occur after childbirth or after lifting heavy objects for a period of time.   A chronic cough can repeatedly strain these connective tissues, leading to a cystocele.   Obese women are more likely to develop a cystocele.

• A cystocele can result from childbirth, constipation, violent coughing, heavy lifting, or other pelvic muscle strain.
• Perceived or discovered BULGE IN THE VAGINA
• pelvic pressure, urinary dysfunction (urgency, frequency, incomplete voiding, urinary retention, urinary incontinence)

Cystocele demonstrating descent of the anterior vaginal wall with a bulge of the bladder into the vagina

Diagnosed with voiding studies, urodynamic studies

A pessary can be inserted to provide extra support to these connective tissues and prevent the bladder from prolapsing into the vagina.

If symptoms are very bothersome and not relieved with more conservative measures, surgery may be necessary to strengthen the support underneath the bladder.

• Conservative therapy: Kegel exercises, pelvic floor retraining, behavioral
• Pessary placement
• Surgical repair with mesh augmentation