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

• This results in a bulge (prolapse) of the posterior bladder into the anterior 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.
• Perceived or discovered BULGE IN THE VAGINA
• May present with difficulty starting urine stream, feeling of incomplete emptying of bladder, and frequency or urgency of urination
  • May also have leakage of urine (stress incontinence)

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

Tests for a cystocele include a pelvic exam and urodynamic studies

• A tissue bulge into the vagina indicates pelvic organ prolapse
• A urinalysis should be performed on all patients

Those with few or no obvious symptoms typically don't require treatment.

For those with symptoms:

• Kegel exercises, pelvic floor retraining, behavioral therapies, and weight loss
• 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