Materiały źródłowe

• #1 Anterior vaginal prolapse (cystocele) – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/cystocele/symptoms-causes/syc-20369452

  A dropped or prolapsed bladder (cystocele) occurs when the bladder bulges into the vaginal space. It results when the muscles and tissues that support the bladder give way. […] Anterior prolapse occurs when the pelvic floor becomes weak or if too much pressure is put on the pelvic floor. This can happen over time, during vaginal childbirth or with chronic constipation, violent coughing or heavy lifting. […] Your pelvic floor consists of muscles, ligaments and connective tissues that support your bladder and other pelvic organs. The connections between your pelvic organs and ligaments can weaken over time, or as a result of trauma from childbirth or chronic straining. When this happens, your bladder can slip down lower than usual and bulge into your vagina (anterior prolapse).

• #2 Evaluation and Management of Anterior Vaginal Wall Prolapse | SpringerLink

  https://link.springer.com/chapter/10.1007/978-1-59745-368-4_19

  Prolapse of the anterior vaginal wall is the most common presentation of pelvic organ prolapse. […] In addition, normal anterior vaginal support plays an important role in supporting the urethra, and loss of this support can contribute to the development of stress urinary incontinence. […] It is therefore important that the pelvic reconstructive surgeon understand the normal support mechanisms of the anterior vaginal wall and the full spectrum of techniques for correction of anterior vaginal prolapse and cystoceles.

• #3 Anterior vaginal prolapse (cystocele) – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/cystocele/symptoms-causes/syc-20369452

  A dropped or prolapsed bladder (cystocele) occurs when the bladder bulges into the vaginal space. It results when the muscles and tissues that support the bladder give way. […] Anterior prolapse occurs when the pelvic floor becomes weak or if too much pressure is put on the pelvic floor. This can happen over time, during vaginal childbirth or with chronic constipation, violent coughing or heavy lifting. […] Your pelvic floor consists of muscles, ligaments and connective tissues that support your bladder and other pelvic organs. The connections between your pelvic organs and ligaments can weaken over time, or as a result of trauma from childbirth or chronic straining. When this happens, your bladder can slip down lower than usual and bulge into your vagina (anterior prolapse).

• #4 Cystocele (Prolapsed Bladder): Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/15468-cystocele-fallen-bladder

  A cystocele is a type of pelvic organ prolapse that allows your vaginal wall and bladder to bulge into your vagina. […] A cystocele is a condition in which the supportive ligaments and muscles around your bladder and vaginal wall that hold up your bladder stretch or weaken. This allows your bladder to sag into your vagina. Its a type of pelvic organ prolapse. […] Stretched or weakened pelvic ligaments cause cystoceles. Many different factors can damage the ligaments. These include: Vaginal births, which may strain the muscles in your pelvic floor. […] A cystocele can push on your urethra and prevent your bladder from completely emptying when you pee (urinary retention). It can also twist your ureters. Your ureters are two tubes that move pee from your kidneys to your bladder. A buildup of pee in your kidneys can cause kidney damage. […] A moderate or severe cystocele may require an anterior colporrhaphy. An anterior colporrhaphy is a type of reconstructive surgery in which a surgeon moves your bladder back into its normal position and tightens the muscles in the front wall that hold your bladder in place.

• #5 Pelvic Organ Prolapse – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK563229/

  Pelvic organ prolapse (POP) is a gynecological condition in which the pelvic organs herniate into the vagina due to ligament or muscular weakness. […] Cystocele characterizes anterior wall herniation, rectocele refers to the posterior vaginal wall descent, and vaginal vault prolapse characterizes the descent of the uterus, cervix, or apex of the vagina. […] Although the etiology of POP is multifactorial, there is a high correlation between pregnancy and vaginal delivery, which can lead to direct pelvic floor muscle and connective tissue injury. […] Additionally, prior pelvic surgeries or conditions associated with sustained episodes of increased intrabdominal pressure, such as heavy lifting, obesity, chronic cough, and constipation, can increase the risk of developing POP. […] DeLancey demonstrated that normal pelvic support is provided by the interaction between the levator ani muscle group and connective tissue attachments that stabilize the vagina at varying levels.

• #6 Pelvic Organ Prolapse – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK563229/

  Any weakness or tears within the connective tissue leads to the varying pathology of pelvic floor defects. […] With normal pelvic support, the vagina lies horizontally on top of the levator and muscles. […] Damage causes the levator ani muscles to become more vertical in orientation, opening the vagina and thus shifting support to the connective tissue attachments. […] Through biomechanical modeling, it was postulated that the second stage of labor causes the levator ani muscles to stretch more than 200% beyond the threshold for injury. […] Pelvic organ prolapse (POP) is a common condition that is multifactorial in etiology. […] Combinations of anatomical, physiological, genetic, lifestyle, and reproductive factors contribute to pelvic floor dysfunction throughout a woman’s lifespan.

• #7 Pelvic Organ Prolapse – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK563229/

  Any weakness or tears within the connective tissue leads to the varying pathology of pelvic floor defects. […] With normal pelvic support, the vagina lies horizontally on top of the levator and muscles. […] Damage causes the levator ani muscles to become more vertical in orientation, opening the vagina and thus shifting support to the connective tissue attachments. […] Through biomechanical modeling, it was postulated that the second stage of labor causes the levator ani muscles to stretch more than 200% beyond the threshold for injury. […] Pelvic organ prolapse (POP) is a common condition that is multifactorial in etiology. […] Combinations of anatomical, physiological, genetic, lifestyle, and reproductive factors contribute to pelvic floor dysfunction throughout a woman’s lifespan.

• #8 Pathophysiology of Pelvic Organ Prolapse | IntechOpen

  https://www.intechopen.com/chapters/60935

  Disruption in pubocervical fascia results in cystocele. […] Petros and DeLanceys anatomic/functional theories of bladder support structures discriminated three types of cystocele include apical, medial, and lateral or paravaginal. […] Apical cystocele is due to anatomic defect in the upper third of the vagina which include endopelvic fascia and DeLanceys level 1 ligament complex. […] Medial cystocele relates to the cervical ring defect. […] Defects in Uterosacral ligaments and the Pubocervical fascia result in 75% of high-grade cystoceles. […] Other factors such as obstructed voiding symptoms may be indicators of prolapse severity or absence of vaginal rugae also may suggest the location of certain anterior wall support defects. […] They postulated that anterior vaginal prolapse dependent on the degree of impairment sustained by the pubovisceral muscle and the cardinal/uterosacral ligament complex under raised intra-abdominal pressure.

• #9 KoreaMed Synapse

  https://synapse.koreamed.org/articles/1006197

  Anterior vaginal wall prolapse is defined as the descent of the anterior vagina such that the urethro-vesical junction (a point 3-cm proximal to the external urethral meatus) or any anterior point proximal to this is less than 3 cm above the plane of the hymen. Cystocele is classified as a paravaginal defect (lateral, displacement), midline defect (central, distention), or transverse defect (apical) when the pubocervical fascia separates from the vaginal cuff or uterosacral ligaments or a combination of these defects. […] Lateral cystocele is caused by the detachment of the pubocervical fascia and pubourethral ligaments from the arcus tendineus fasciae pelvis (ATFP). According to the mechanism of lateral cystocele, the purpose of the proposed operation is the correction of the relaxed or detached pubocervical and pubourethral ligaments.

• #10 Cystocele Repair: Overview, Technique, Periprocedural Care

  https://emedicine.medscape.com/article/1848220-overview

  Pelvic organ prolapse (POP), including cystocele, is a major health concern, especially in the elderly. […] Disruption of 1 or more of these support structures might precipitate POP, including cystocele. […] Depending on the site of fascial detachment, cystocele can be central (midline defect of the pericervical fascia; about 1% of cases), lateral (detachment of the pericervical fascia from the ATFP; about 80-85% of cases), or apical (detachment from the uterosacral ligaments or the pericervical ring; about 15% of cases). […] The risk factors for developing POP include age, parity, obesity, chronic constipation, hormonal status, previous gynecologic surgery and hysterectomy, chronic obstructive airway disease, smoking, high-impact activity, and genetics. […] Urinary symptoms associated with cystocele include urinary frequency and urgency (35%), urge urinary incontinence (15%), stress urinary incontinence (60%), and difficulty voiding (23%).

• #11 Types of Vaginal Prolapse

  https://www.contemporaryobgyn.net/view/types-vaginal-prolapse

  Cystocele midline or central defect – (side view) – This patient has a cystocele due to a midline or central defect on the pubocervical fascia (support system). Now the bladder is sagging in the area lacking fascia. To repair this area an anterior repair should be performed to specifically correct the pubocervical fascia defect. […] Cystocele (Midline Defect) – Vaginal View – here the skin has been pulled back to demonstrate the hole or defect in the pubocervical fascia (supportive layer). The defect in the supportive layer allows the bladder to come in direct contact with the vaginal skin resulting in a cystocele.

• #12 Cystocele Repair: Overview, Technique, Periprocedural Care

  https://emedicine.medscape.com/article/1848220-overview

  Pelvic organ prolapse (POP), including cystocele, is a major health concern, especially in the elderly. […] Disruption of 1 or more of these support structures might precipitate POP, including cystocele. […] Depending on the site of fascial detachment, cystocele can be central (midline defect of the pericervical fascia; about 1% of cases), lateral (detachment of the pericervical fascia from the ATFP; about 80-85% of cases), or apical (detachment from the uterosacral ligaments or the pericervical ring; about 15% of cases). […] The risk factors for developing POP include age, parity, obesity, chronic constipation, hormonal status, previous gynecologic surgery and hysterectomy, chronic obstructive airway disease, smoking, high-impact activity, and genetics. […] Urinary symptoms associated with cystocele include urinary frequency and urgency (35%), urge urinary incontinence (15%), stress urinary incontinence (60%), and difficulty voiding (23%).

• #13 KoreaMed Synapse

  https://synapse.koreamed.org/articles/1006197

  Anterior vaginal wall prolapse is defined as the descent of the anterior vagina such that the urethro-vesical junction (a point 3-cm proximal to the external urethral meatus) or any anterior point proximal to this is less than 3 cm above the plane of the hymen. Cystocele is classified as a paravaginal defect (lateral, displacement), midline defect (central, distention), or transverse defect (apical) when the pubocervical fascia separates from the vaginal cuff or uterosacral ligaments or a combination of these defects. […] Lateral cystocele is caused by the detachment of the pubocervical fascia and pubourethral ligaments from the arcus tendineus fasciae pelvis (ATFP). According to the mechanism of lateral cystocele, the purpose of the proposed operation is the correction of the relaxed or detached pubocervical and pubourethral ligaments.

• #14 Cystocele Repair: Overview, Technique, Periprocedural Care

  https://emedicine.medscape.com/article/1848220-overview

  Pelvic organ prolapse (POP), including cystocele, is a major health concern, especially in the elderly. […] Disruption of 1 or more of these support structures might precipitate POP, including cystocele. […] Depending on the site of fascial detachment, cystocele can be central (midline defect of the pericervical fascia; about 1% of cases), lateral (detachment of the pericervical fascia from the ATFP; about 80-85% of cases), or apical (detachment from the uterosacral ligaments or the pericervical ring; about 15% of cases). […] The risk factors for developing POP include age, parity, obesity, chronic constipation, hormonal status, previous gynecologic surgery and hysterectomy, chronic obstructive airway disease, smoking, high-impact activity, and genetics. […] Urinary symptoms associated with cystocele include urinary frequency and urgency (35%), urge urinary incontinence (15%), stress urinary incontinence (60%), and difficulty voiding (23%).

• #15 Structural Failure Sites in Anterior Vaginal Wall Prolapse: Identification of a Collinear Triad

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5218807/

  We identified a collinear triad consisting of apical location, paravaginal location, and hiatus size that were not only the strongest predictors of cystocele size, but were also highly correlated with one another (r = 0.84 0.89, p 0.001) for the presence and size of the prolapse. […] Apical location, paravaginal location, and hiatus size are highly correlated, and are strong predictors of cystocele presence and size. […] Four connective tissue failure sites are often discussed as causal factors contributing to cystocele formation. Two failure sites concern the attachment of the vaginal wall to surrounding structures (that we will refer to as attachment factors) and include apical support and paravaginal defects. […] Mechanistically, perhaps the most important finding is discovery of the collinear triad. This observation demonstrates that these individual factors previously postulated as separate failure sites are actually facets of a singular and more complex support failure phenomenon.

• #16 Structural Failure Sites in Anterior Vaginal Wall Prolapse: Identification of a Collinear Triad

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5218807/

  We identified a collinear triad consisting of apical location, paravaginal location, and hiatus size that were not only the strongest predictors of cystocele size, but were also highly correlated with one another (r = 0.84 0.89, p 0.001) for the presence and size of the prolapse. […] Apical location, paravaginal location, and hiatus size are highly correlated, and are strong predictors of cystocele presence and size. […] Four connective tissue failure sites are often discussed as causal factors contributing to cystocele formation. Two failure sites concern the attachment of the vaginal wall to surrounding structures (that we will refer to as attachment factors) and include apical support and paravaginal defects. […] Mechanistically, perhaps the most important finding is discovery of the collinear triad. This observation demonstrates that these individual factors previously postulated as separate failure sites are actually facets of a singular and more complex support failure phenomenon.

• #17 Structural Failure Sites in Anterior Vaginal Wall Prolapse: Identification of a Collinear Triad

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5218807/

  We identified a collinear triad consisting of apical location, paravaginal location, and hiatus size that were not only the strongest predictors of cystocele size, but were also highly correlated with one another (r = 0.84 0.89, p 0.001) for the presence and size of the prolapse. […] Apical location, paravaginal location, and hiatus size are highly correlated, and are strong predictors of cystocele presence and size. […] Four connective tissue failure sites are often discussed as causal factors contributing to cystocele formation. Two failure sites concern the attachment of the vaginal wall to surrounding structures (that we will refer to as attachment factors) and include apical support and paravaginal defects. […] Mechanistically, perhaps the most important finding is discovery of the collinear triad. This observation demonstrates that these individual factors previously postulated as separate failure sites are actually facets of a singular and more complex support failure phenomenon.

• #18 Anterior vaginal prolapse (cystocele) | UM Health-Sparrow

  https://www.uofmhealthsparrow.org/departments-conditions/conditions/anterior-vaginal-prolapse-cystocele

  Causes of stress to the pelvic floor include: Pregnancy and vaginal childbirth, Being overweight or obese, Repeated heavy lifting, Straining with bowel movements, A chronic cough or bronchitis. […] Women who have had a vaginal or instrument-assisted delivery, multiple pregnancies, or whose infants had a high birth weight have a higher risk of anterior prolapse. […] Your risk of anterior prolapse increases as you age. This is especially true after menopause, when your body’s production of estrogen which helps keep the pelvic floor strong decreases. […] Having your uterus removed may contribute to weakness in your pelvic floor, but this is not always the case. […] Some women are born with weaker connective tissues, making them more susceptible to anterior prolapse. […] Women who are overweight or obese are at higher risk of anterior prolapse.

• #19 Anterior vaginal prolapse (cystocele) – Hancock Health

  https://www.hancockhealth.org/mayo-health-library/anterior-vaginal-prolapse-cystocele/

  Anterior vaginal prolapse occurs when the pelvic floor becomes weak or if too much pressure is put on the pelvic floor. […] The connections between your pelvic organs and ligaments can weaken over time, or as a result of trauma from childbirth or chronic straining. When this happens, your bladder can slip down lower than usual and bulge into your vagina (anterior prolapse). […] Causes of stress to the pelvic floor include pregnancy and vaginal childbirth, being overweight or obese, repeated heavy lifting, straining with bowel movements, and a chronic cough or bronchitis. […] These factors may increase your risk of anterior prolapse: Pregnancy and childbirth, Aging, Hysterectomy, Genetics, Obesity. […] If you still have noticeable, uncomfortable symptoms despite the treatment options above, you may need surgery to fix the prolapse. […] Often, the surgery is performed vaginally and involves lifting the prolapsed bladder back into place using stitches and removing any excess vaginal tissue.

• #20 Pelvic Organ Prolapse – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK563229/

  Any weakness or tears within the connective tissue leads to the varying pathology of pelvic floor defects. […] With normal pelvic support, the vagina lies horizontally on top of the levator and muscles. […] Damage causes the levator ani muscles to become more vertical in orientation, opening the vagina and thus shifting support to the connective tissue attachments. […] Through biomechanical modeling, it was postulated that the second stage of labor causes the levator ani muscles to stretch more than 200% beyond the threshold for injury. […] Pelvic organ prolapse (POP) is a common condition that is multifactorial in etiology. […] Combinations of anatomical, physiological, genetic, lifestyle, and reproductive factors contribute to pelvic floor dysfunction throughout a woman’s lifespan.

• #21 Pelvic Organ Prolapse | AAFP

  https://www.aafp.org/pubs/afp/issues/2017/0801/p179.html

  Pelvic organ prolapse is the descent of one or more of the anterior vaginal wall, posterior vaginal wall, the uterus (cervix), or the apex of the vagina (vaginal vault or cuff scar after hysterectomy). Prevalence increases with age. The cause of prolapse is multifactorial but is primarily associated with pregnancy and vaginal delivery, which lead to direct pelvic floor muscle and connective tissue injury. Hysterectomy, pelvic surgery, and conditions associated with sustained episodes of increased intra-abdominal pressure, including obesity, chronic cough, constipation, and repeated heavy lifting, also contribute to prolapse. […] The cause of pelvic organ prolapse is multifactorial, but pregnancy is the most commonly associated risk factor. Normal pelvic support is primarily provided by the levator ani muscles and the connective tissue attachments of the vagina to the sidewalls and pelvis. With normal pelvic support, the vagina lies horizontally atop the levator ani muscles. When damaged, the levator ani muscles become more vertical in orientation and the vaginal opening widens, shifting support to the connective tissue attachments. Biomechanical modeling has demonstrated that during the second stage of labor, levator ani muscles are stretched more than 200% beyond the threshold for stretch injuries.

• #22 Anterior vaginal prolapse (cystocele) | UM Health-Sparrow

  https://www.uofmhealthsparrow.org/departments-conditions/conditions/anterior-vaginal-prolapse-cystocele

  Causes of stress to the pelvic floor include: Pregnancy and vaginal childbirth, Being overweight or obese, Repeated heavy lifting, Straining with bowel movements, A chronic cough or bronchitis. […] Women who have had a vaginal or instrument-assisted delivery, multiple pregnancies, or whose infants had a high birth weight have a higher risk of anterior prolapse. […] Your risk of anterior prolapse increases as you age. This is especially true after menopause, when your body’s production of estrogen which helps keep the pelvic floor strong decreases. […] Having your uterus removed may contribute to weakness in your pelvic floor, but this is not always the case. […] Some women are born with weaker connective tissues, making them more susceptible to anterior prolapse. […] Women who are overweight or obese are at higher risk of anterior prolapse.

• #23 Anterior vaginal prolapse (cystocele) | UM Health-Sparrow

  https://www.uofmhealthsparrow.org/departments-conditions/conditions/anterior-vaginal-prolapse-cystocele

  Causes of stress to the pelvic floor include: Pregnancy and vaginal childbirth, Being overweight or obese, Repeated heavy lifting, Straining with bowel movements, A chronic cough or bronchitis. […] Women who have had a vaginal or instrument-assisted delivery, multiple pregnancies, or whose infants had a high birth weight have a higher risk of anterior prolapse. […] Your risk of anterior prolapse increases as you age. This is especially true after menopause, when your body’s production of estrogen which helps keep the pelvic floor strong decreases. […] Having your uterus removed may contribute to weakness in your pelvic floor, but this is not always the case. […] Some women are born with weaker connective tissues, making them more susceptible to anterior prolapse. […] Women who are overweight or obese are at higher risk of anterior prolapse.

• #24 Pathophysiology of Pelvic Organ Prolapse | IntechOpen

  https://www.intechopen.com/chapters/60935

  Age and POP relation is hypothesized to be secondary to numerous factors including physiologic changes of the pelvic floor components and decline in estrogen during the postmenopausal period with advance age. […] There are hormonal induced physiological changes that occur in pelvic floor musculature and connective tissue during pregnancy. […] Changes in biomechanical properties of the vaginal wall have been studied in fibulin-5 knockout mice (Fbln5/) with and without prolapse. […] The causative links between childbirth and prolapse have shown by various epidemiological and observational cohort studies. […] There is increased prevalence of true rectocele after vaginal childbirth as proven by many studies. […] Chronically raised intra-abdominal pressure such as chronic constipation, higher body mass index (BMI), chronic cough, and repetitive heavy weight lifting seems to play a role in POP pathogenesis.

• #25 Pathophysiology of Pelvic Organ Prolapse | IntechOpen

  https://www.intechopen.com/chapters/60935

  Pelvic organ support is provided by interaction between the pelvic floor muscle, ligaments and its connective tissues. […] Failure of anatomical support may result in pelvic organ prolapse. […] To appropriately treat these entities, comprehension of the various theories of the pathophysiology of pelvic organ prolapse is of paramount importance. […] A better understanding of pathophysiology of muscular, collagen, and neuronal components of the pelvic organs and their support would provide an insight of site specific defects and its prevention. […] Age has been recognized as an intrinsic factor in the development of pelvic floor dysfunction and most consensuses in favor that it has a role in the etiology of female pelvic organ prolapse (POP). […] The relative prevalence of POP increased by about 40% with every decade of life.

• #26 Anterior vaginal prolapse (cystocele) | UM Health-Sparrow

  https://www.uofmhealthsparrow.org/departments-conditions/conditions/anterior-vaginal-prolapse-cystocele

  Causes of stress to the pelvic floor include: Pregnancy and vaginal childbirth, Being overweight or obese, Repeated heavy lifting, Straining with bowel movements, A chronic cough or bronchitis. […] Women who have had a vaginal or instrument-assisted delivery, multiple pregnancies, or whose infants had a high birth weight have a higher risk of anterior prolapse. […] Your risk of anterior prolapse increases as you age. This is especially true after menopause, when your body’s production of estrogen which helps keep the pelvic floor strong decreases. […] Having your uterus removed may contribute to weakness in your pelvic floor, but this is not always the case. […] Some women are born with weaker connective tissues, making them more susceptible to anterior prolapse. […] Women who are overweight or obese are at higher risk of anterior prolapse.

• #27 Pathophysiology of Pelvic Organ Prolapse | IntechOpen

  https://www.intechopen.com/chapters/60935

  Age and POP relation is hypothesized to be secondary to numerous factors including physiologic changes of the pelvic floor components and decline in estrogen during the postmenopausal period with advance age. […] There are hormonal induced physiological changes that occur in pelvic floor musculature and connective tissue during pregnancy. […] Changes in biomechanical properties of the vaginal wall have been studied in fibulin-5 knockout mice (Fbln5/) with and without prolapse. […] The causative links between childbirth and prolapse have shown by various epidemiological and observational cohort studies. […] There is increased prevalence of true rectocele after vaginal childbirth as proven by many studies. […] Chronically raised intra-abdominal pressure such as chronic constipation, higher body mass index (BMI), chronic cough, and repetitive heavy weight lifting seems to play a role in POP pathogenesis.

• #28 Anterior vaginal prolapse (cystocele) | UM Health-Sparrow

  https://www.uofmhealthsparrow.org/departments-conditions/conditions/anterior-vaginal-prolapse-cystocele

  Causes of stress to the pelvic floor include: Pregnancy and vaginal childbirth, Being overweight or obese, Repeated heavy lifting, Straining with bowel movements, A chronic cough or bronchitis. […] Women who have had a vaginal or instrument-assisted delivery, multiple pregnancies, or whose infants had a high birth weight have a higher risk of anterior prolapse. […] Your risk of anterior prolapse increases as you age. This is especially true after menopause, when your body’s production of estrogen which helps keep the pelvic floor strong decreases. […] Having your uterus removed may contribute to weakness in your pelvic floor, but this is not always the case. […] Some women are born with weaker connective tissues, making them more susceptible to anterior prolapse. […] Women who are overweight or obese are at higher risk of anterior prolapse.

• #29 Pathophysiology of Pelvic Organ Prolapse | IntechOpen

  https://www.intechopen.com/chapters/60935

  Morbid obesity was associated with 40% increase in the occurrence of uterine prolapse, 75% with rectocele and 57% with cystocele. […] Risk of subsequent pelvic organ prolapse is increased by hysterectomy however it takes years for development of symptomatic prolapse. […] DeLancey has described vaginal connective tissue support of the pelvis into three levels that help to understand various clinical manifestations of pelvic organ support dysfunction. […] The anterior compartment receives level I support at the pericervical ring whereas level II support is provided at the mid portion of anterior vagina which is attached laterally to the arcus tendineus fascia of the pelvic sidewall. […] The ATFPs act as suspension cables on either side of the vagina and bladder, harbor them to the pelvic wall and its detachment induces pelvic imbalance that may lead to lateral cystocele.

• #30 Anterior vaginal prolapse (cystocele) | UM Health-Sparrow

  https://www.uofmhealthsparrow.org/departments-conditions/conditions/anterior-vaginal-prolapse-cystocele

  Causes of stress to the pelvic floor include: Pregnancy and vaginal childbirth, Being overweight or obese, Repeated heavy lifting, Straining with bowel movements, A chronic cough or bronchitis. […] Women who have had a vaginal or instrument-assisted delivery, multiple pregnancies, or whose infants had a high birth weight have a higher risk of anterior prolapse. […] Your risk of anterior prolapse increases as you age. This is especially true after menopause, when your body’s production of estrogen which helps keep the pelvic floor strong decreases. […] Having your uterus removed may contribute to weakness in your pelvic floor, but this is not always the case. […] Some women are born with weaker connective tissues, making them more susceptible to anterior prolapse. […] Women who are overweight or obese are at higher risk of anterior prolapse.

• #31 What is Prolapse? – Pure Pelvic Health

  https://purepelvichealth.ca/blog/what-is-prolapse/

  Anterior vaginal wall or cystocele prolapse is sometimes referred to as a cystocele. It occurs when the structures in front of the vagina, such as the bladder, push into the vaginal space. […] A prolapse occurs when the support structures for the pelvic organs and the pelvic floor muscles can no longer adequately support the pelvic organs. […] Connective tissue disorders, such as Ehlers-Danlos syndrome, can predispose you to prolapse. In these disorders the connective tissues that support the pelvic organs are not as strong and are not able to provide adequate support over time.

• #32 Pathophysiology of Pelvic Organ Prolapse | IntechOpen

  https://www.intechopen.com/chapters/60935

  They demonstrated the loss of support of the levator ani muscles leads to downward rotation of the levator plate (trap door opens), and widening of the urogenital hiatus, and worsening anterior vaginal wall prolapse, trap door theory effect. […] Comprehensively, it has been reviewed that abnormal synthesis or degradation of collagen and elastin fibers of the vaginal wall contributes to the pathophysiology of prolapse. […] The connective tissues of the vagina and supportive tissues comprise predominantly of fibrillar component (collagen and elastin) embedded in a non-fibrillar component (noncollagenous glycoproteins, hyaluronan, and proteoglycans). […] The matrix metalloproteinases (MMPs) is proteolytic enzyme involved in both physiological and pathological tissue remodeling in women with and without prolapse.

• #33 Pathophysiology of Pelvic Organ Prolapse | IntechOpen

  https://www.intechopen.com/chapters/60935

  They demonstrated the loss of support of the levator ani muscles leads to downward rotation of the levator plate (trap door opens), and widening of the urogenital hiatus, and worsening anterior vaginal wall prolapse, trap door theory effect. […] Comprehensively, it has been reviewed that abnormal synthesis or degradation of collagen and elastin fibers of the vaginal wall contributes to the pathophysiology of prolapse. […] The connective tissues of the vagina and supportive tissues comprise predominantly of fibrillar component (collagen and elastin) embedded in a non-fibrillar component (noncollagenous glycoproteins, hyaluronan, and proteoglycans). […] The matrix metalloproteinases (MMPs) is proteolytic enzyme involved in both physiological and pathological tissue remodeling in women with and without prolapse.

• #34 Pathophysiology of Pelvic Organ Prolapse | IntechOpen

  https://www.intechopen.com/chapters/60935

  They demonstrated the loss of support of the levator ani muscles leads to downward rotation of the levator plate (trap door opens), and widening of the urogenital hiatus, and worsening anterior vaginal wall prolapse, trap door theory effect. […] Comprehensively, it has been reviewed that abnormal synthesis or degradation of collagen and elastin fibers of the vaginal wall contributes to the pathophysiology of prolapse. […] The connective tissues of the vagina and supportive tissues comprise predominantly of fibrillar component (collagen and elastin) embedded in a non-fibrillar component (noncollagenous glycoproteins, hyaluronan, and proteoglycans). […] The matrix metalloproteinases (MMPs) is proteolytic enzyme involved in both physiological and pathological tissue remodeling in women with and without prolapse.

• #35 Pathophysiology of Pelvic Organ Prolapse | IntechOpen

  https://www.intechopen.com/chapters/60935

  The proteolytic activity in turn is regulated by inhibitors, TIMPs who bind with MMPS and inhibit its activity. […] Thus the increased stretchability and distensibility and decline in tensile strength associated with a higher content of collagen III are likely to contribute to the progression of POP.

• #36 Pathophysiology of Pelvic Organ Prolapse | IntechOpen

  https://www.intechopen.com/chapters/60935

  The proteolytic activity in turn is regulated by inhibitors, TIMPs who bind with MMPS and inhibit its activity. […] Thus the increased stretchability and distensibility and decline in tensile strength associated with a higher content of collagen III are likely to contribute to the progression of POP.

• #37 Pathophysiology of Pelvic Organ Prolapse | IntechOpen

  https://www.intechopen.com/chapters/60935

  Disruption in pubocervical fascia results in cystocele. […] Petros and DeLanceys anatomic/functional theories of bladder support structures discriminated three types of cystocele include apical, medial, and lateral or paravaginal. […] Apical cystocele is due to anatomic defect in the upper third of the vagina which include endopelvic fascia and DeLanceys level 1 ligament complex. […] Medial cystocele relates to the cervical ring defect. […] Defects in Uterosacral ligaments and the Pubocervical fascia result in 75% of high-grade cystoceles. […] Other factors such as obstructed voiding symptoms may be indicators of prolapse severity or absence of vaginal rugae also may suggest the location of certain anterior wall support defects. […] They postulated that anterior vaginal prolapse dependent on the degree of impairment sustained by the pubovisceral muscle and the cardinal/uterosacral ligament complex under raised intra-abdominal pressure.

• #38 Pathophysiology of Pelvic Organ Prolapse | IntechOpen

  https://www.intechopen.com/chapters/60935

  They demonstrated the loss of support of the levator ani muscles leads to downward rotation of the levator plate (trap door opens), and widening of the urogenital hiatus, and worsening anterior vaginal wall prolapse, trap door theory effect. […] Comprehensively, it has been reviewed that abnormal synthesis or degradation of collagen and elastin fibers of the vaginal wall contributes to the pathophysiology of prolapse. […] The connective tissues of the vagina and supportive tissues comprise predominantly of fibrillar component (collagen and elastin) embedded in a non-fibrillar component (noncollagenous glycoproteins, hyaluronan, and proteoglycans). […] The matrix metalloproteinases (MMPs) is proteolytic enzyme involved in both physiological and pathological tissue remodeling in women with and without prolapse.

• #39 Pelvic Organ Prolapse – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK563229/

  Any weakness or tears within the connective tissue leads to the varying pathology of pelvic floor defects. […] With normal pelvic support, the vagina lies horizontally on top of the levator and muscles. […] Damage causes the levator ani muscles to become more vertical in orientation, opening the vagina and thus shifting support to the connective tissue attachments. […] Through biomechanical modeling, it was postulated that the second stage of labor causes the levator ani muscles to stretch more than 200% beyond the threshold for injury. […] Pelvic organ prolapse (POP) is a common condition that is multifactorial in etiology. […] Combinations of anatomical, physiological, genetic, lifestyle, and reproductive factors contribute to pelvic floor dysfunction throughout a woman’s lifespan.

• #40 Anterior vaginal prolapse (cystocele) – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/cystocele/symptoms-causes/syc-20369452

  A dropped or prolapsed bladder (cystocele) occurs when the bladder bulges into the vaginal space. It results when the muscles and tissues that support the bladder give way. […] Anterior prolapse occurs when the pelvic floor becomes weak or if too much pressure is put on the pelvic floor. This can happen over time, during vaginal childbirth or with chronic constipation, violent coughing or heavy lifting. […] Your pelvic floor consists of muscles, ligaments and connective tissues that support your bladder and other pelvic organs. The connections between your pelvic organs and ligaments can weaken over time, or as a result of trauma from childbirth or chronic straining. When this happens, your bladder can slip down lower than usual and bulge into your vagina (anterior prolapse).

• #41 Pathophysiology of Pelvic Organ Prolapse | IntechOpen

  https://www.intechopen.com/chapters/60935

  Disruption in pubocervical fascia results in cystocele. […] Petros and DeLanceys anatomic/functional theories of bladder support structures discriminated three types of cystocele include apical, medial, and lateral or paravaginal. […] Apical cystocele is due to anatomic defect in the upper third of the vagina which include endopelvic fascia and DeLanceys level 1 ligament complex. […] Medial cystocele relates to the cervical ring defect. […] Defects in Uterosacral ligaments and the Pubocervical fascia result in 75% of high-grade cystoceles. […] Other factors such as obstructed voiding symptoms may be indicators of prolapse severity or absence of vaginal rugae also may suggest the location of certain anterior wall support defects. […] They postulated that anterior vaginal prolapse dependent on the degree of impairment sustained by the pubovisceral muscle and the cardinal/uterosacral ligament complex under raised intra-abdominal pressure.

• #42 Pathophysiology of Pelvic Organ Prolapse | IntechOpen

  https://www.intechopen.com/chapters/60935

  Disruption in pubocervical fascia results in cystocele. […] Petros and DeLanceys anatomic/functional theories of bladder support structures discriminated three types of cystocele include apical, medial, and lateral or paravaginal. […] Apical cystocele is due to anatomic defect in the upper third of the vagina which include endopelvic fascia and DeLanceys level 1 ligament complex. […] Medial cystocele relates to the cervical ring defect. […] Defects in Uterosacral ligaments and the Pubocervical fascia result in 75% of high-grade cystoceles. […] Other factors such as obstructed voiding symptoms may be indicators of prolapse severity or absence of vaginal rugae also may suggest the location of certain anterior wall support defects. […] They postulated that anterior vaginal prolapse dependent on the degree of impairment sustained by the pubovisceral muscle and the cardinal/uterosacral ligament complex under raised intra-abdominal pressure.

• #43 Pathophysiology of Pelvic Organ Prolapse | IntechOpen

  https://www.intechopen.com/chapters/60935

  Disruption in pubocervical fascia results in cystocele. […] Petros and DeLanceys anatomic/functional theories of bladder support structures discriminated three types of cystocele include apical, medial, and lateral or paravaginal. […] Apical cystocele is due to anatomic defect in the upper third of the vagina which include endopelvic fascia and DeLanceys level 1 ligament complex. […] Medial cystocele relates to the cervical ring defect. […] Defects in Uterosacral ligaments and the Pubocervical fascia result in 75% of high-grade cystoceles. […] Other factors such as obstructed voiding symptoms may be indicators of prolapse severity or absence of vaginal rugae also may suggest the location of certain anterior wall support defects. […] They postulated that anterior vaginal prolapse dependent on the degree of impairment sustained by the pubovisceral muscle and the cardinal/uterosacral ligament complex under raised intra-abdominal pressure.

• #44 Pathophysiology of Pelvic Organ Prolapse | IntechOpen

  https://www.intechopen.com/chapters/60935

  Disruption in pubocervical fascia results in cystocele. […] Petros and DeLanceys anatomic/functional theories of bladder support structures discriminated three types of cystocele include apical, medial, and lateral or paravaginal. […] Apical cystocele is due to anatomic defect in the upper third of the vagina which include endopelvic fascia and DeLanceys level 1 ligament complex. […] Medial cystocele relates to the cervical ring defect. […] Defects in Uterosacral ligaments and the Pubocervical fascia result in 75% of high-grade cystoceles. […] Other factors such as obstructed voiding symptoms may be indicators of prolapse severity or absence of vaginal rugae also may suggest the location of certain anterior wall support defects. […] They postulated that anterior vaginal prolapse dependent on the degree of impairment sustained by the pubovisceral muscle and the cardinal/uterosacral ligament complex under raised intra-abdominal pressure.

• #45 Cystocele (Prolapsed Bladder): Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/15468-cystocele-fallen-bladder

  A cystocele is a type of pelvic organ prolapse that allows your vaginal wall and bladder to bulge into your vagina. […] A cystocele is a condition in which the supportive ligaments and muscles around your bladder and vaginal wall that hold up your bladder stretch or weaken. This allows your bladder to sag into your vagina. Its a type of pelvic organ prolapse. […] Stretched or weakened pelvic ligaments cause cystoceles. Many different factors can damage the ligaments. These include: Vaginal births, which may strain the muscles in your pelvic floor. […] A cystocele can push on your urethra and prevent your bladder from completely emptying when you pee (urinary retention). It can also twist your ureters. Your ureters are two tubes that move pee from your kidneys to your bladder. A buildup of pee in your kidneys can cause kidney damage. […] A moderate or severe cystocele may require an anterior colporrhaphy. An anterior colporrhaphy is a type of reconstructive surgery in which a surgeon moves your bladder back into its normal position and tightens the muscles in the front wall that hold your bladder in place.

• #46 Cystocele (Prolapsed Bladder): Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/15468-cystocele-fallen-bladder

  A cystocele is a type of pelvic organ prolapse that allows your vaginal wall and bladder to bulge into your vagina. […] A cystocele is a condition in which the supportive ligaments and muscles around your bladder and vaginal wall that hold up your bladder stretch or weaken. This allows your bladder to sag into your vagina. Its a type of pelvic organ prolapse. […] Stretched or weakened pelvic ligaments cause cystoceles. Many different factors can damage the ligaments. These include: Vaginal births, which may strain the muscles in your pelvic floor. […] A cystocele can push on your urethra and prevent your bladder from completely emptying when you pee (urinary retention). It can also twist your ureters. Your ureters are two tubes that move pee from your kidneys to your bladder. A buildup of pee in your kidneys can cause kidney damage. […] A moderate or severe cystocele may require an anterior colporrhaphy. An anterior colporrhaphy is a type of reconstructive surgery in which a surgeon moves your bladder back into its normal position and tightens the muscles in the front wall that hold your bladder in place.

• #47 Cystocele (Prolapsed Bladder): Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/15468-cystocele-fallen-bladder

  A cystocele is a type of pelvic organ prolapse that allows your vaginal wall and bladder to bulge into your vagina. […] A cystocele is a condition in which the supportive ligaments and muscles around your bladder and vaginal wall that hold up your bladder stretch or weaken. This allows your bladder to sag into your vagina. Its a type of pelvic organ prolapse. […] Stretched or weakened pelvic ligaments cause cystoceles. Many different factors can damage the ligaments. These include: Vaginal births, which may strain the muscles in your pelvic floor. […] A cystocele can push on your urethra and prevent your bladder from completely emptying when you pee (urinary retention). It can also twist your ureters. Your ureters are two tubes that move pee from your kidneys to your bladder. A buildup of pee in your kidneys can cause kidney damage. […] A moderate or severe cystocele may require an anterior colporrhaphy. An anterior colporrhaphy is a type of reconstructive surgery in which a surgeon moves your bladder back into its normal position and tightens the muscles in the front wall that hold your bladder in place.

• #48 Cystocele Repair: Overview, Technique, Periprocedural Care

  https://emedicine.medscape.com/article/1848220-overview

  Pelvic organ prolapse (POP), including cystocele, is a major health concern, especially in the elderly. […] Disruption of 1 or more of these support structures might precipitate POP, including cystocele. […] Depending on the site of fascial detachment, cystocele can be central (midline defect of the pericervical fascia; about 1% of cases), lateral (detachment of the pericervical fascia from the ATFP; about 80-85% of cases), or apical (detachment from the uterosacral ligaments or the pericervical ring; about 15% of cases). […] The risk factors for developing POP include age, parity, obesity, chronic constipation, hormonal status, previous gynecologic surgery and hysterectomy, chronic obstructive airway disease, smoking, high-impact activity, and genetics. […] Urinary symptoms associated with cystocele include urinary frequency and urgency (35%), urge urinary incontinence (15%), stress urinary incontinence (60%), and difficulty voiding (23%).

• #49 Pelvic Organ Prolapse: Types, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/24046-pelvic-organ-prolapse

  Pelvic organ prolapse can be uncomfortable and affect your quality of life. Other than urinary and fecal incontinence, some of the other possible complications of a prolapse are: Infection. If the prolapse prevents you from peeing, your pee could back up into your urinary tract or kidneys, causing urinary tract infections (UTIs) or kidney infection. […] Surgery may be an option if your symptoms don’t improve with conservative treatments or if your provider believes surgery gives you the best quality of life moving forward. Be sure to discuss the risks and benefits of surgery with your provider. […] Reconstructive surgery repairs the weak parts of your pelvic floor and moves the organs back to their typical position.

• #50 Pathophysiology of Pelvic Organ Prolapse | IntechOpen

  https://www.intechopen.com/chapters/60935

  Pelvic organ support is provided by interaction between the pelvic floor muscle, ligaments and its connective tissues. […] Failure of anatomical support may result in pelvic organ prolapse. […] To appropriately treat these entities, comprehension of the various theories of the pathophysiology of pelvic organ prolapse is of paramount importance. […] A better understanding of pathophysiology of muscular, collagen, and neuronal components of the pelvic organs and their support would provide an insight of site specific defects and its prevention. […] Age has been recognized as an intrinsic factor in the development of pelvic floor dysfunction and most consensuses in favor that it has a role in the etiology of female pelvic organ prolapse (POP). […] The relative prevalence of POP increased by about 40% with every decade of life.

• #51 Cystocele (Prolapsed Bladder): Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/15468-cystocele-fallen-bladder

  A cystocele is a type of pelvic organ prolapse that allows your vaginal wall and bladder to bulge into your vagina. […] A cystocele is a condition in which the supportive ligaments and muscles around your bladder and vaginal wall that hold up your bladder stretch or weaken. This allows your bladder to sag into your vagina. Its a type of pelvic organ prolapse. […] Stretched or weakened pelvic ligaments cause cystoceles. Many different factors can damage the ligaments. These include: Vaginal births, which may strain the muscles in your pelvic floor. […] A cystocele can push on your urethra and prevent your bladder from completely emptying when you pee (urinary retention). It can also twist your ureters. Your ureters are two tubes that move pee from your kidneys to your bladder. A buildup of pee in your kidneys can cause kidney damage. […] A moderate or severe cystocele may require an anterior colporrhaphy. An anterior colporrhaphy is a type of reconstructive surgery in which a surgeon moves your bladder back into its normal position and tightens the muscles in the front wall that hold your bladder in place.

• #52 Pelvic organ prolapse in women: Surgical repair of anterior vaginal wall prolapse – UpToDate

  https://www.uptodate.com/contents/pelvic-organ-prolapse-in-women-surgical-repair-of-anterior-vaginal-wall-prolapse

  Anterior vaginal wall prolapse describes support abnormalities of the anterior wall of the vagina. Prolapse of the anterior wall typically coexists with prolapse at other anatomic sites (vaginal apex, posterior vaginal wall). The prevailing view is that a common pathogenesis underlies support defects at different sites of the vaginal wall, replacing a previous focus on isolated anatomic compartments. […] Procedures for surgical repair of anterior vaginal wall defects should include repair of apical prolapse, if present. […] Reconstructive procedures for prolapse of the anterior vaginal wall are reviewed here.

• #53 Structural Failure Sites in Anterior Vaginal Wall Prolapse: Identification of a Collinear Triad

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5218807/

  We identified a collinear triad consisting of apical location, paravaginal location, and hiatus size that were not only the strongest predictors of cystocele size, but were also highly correlated with one another (r = 0.84 0.89, p 0.001) for the presence and size of the prolapse. […] Apical location, paravaginal location, and hiatus size are highly correlated, and are strong predictors of cystocele presence and size. […] Four connective tissue failure sites are often discussed as causal factors contributing to cystocele formation. Two failure sites concern the attachment of the vaginal wall to surrounding structures (that we will refer to as attachment factors) and include apical support and paravaginal defects. […] Mechanistically, perhaps the most important finding is discovery of the collinear triad. This observation demonstrates that these individual factors previously postulated as separate failure sites are actually facets of a singular and more complex support failure phenomenon.

• #54 Anterior Colporrhaphy and Paravaginal Repair for Anterior Compartment Prolapse: A Review

  https://www.mdpi.com/1648-9144/60/11/1865

  Plicating or suturing the weakened fascia during procedures like anterior colporrhaphy restores the anteroposterior support of the bladder by reinforcing the connective tissue layer that lies between the bladder and the vaginal wall. […] By plicating or tightening the fascia with sutures, the surgeon strengthens this layer and pulls the bladder back into its normal position. […] Anterior compartment prolapse is the most common type of pelvic organ POP, occurring in 54–79% of women undergoing POP surgery. […] The choice of surgical technique remains controversial, with no clear consensus on the optimal approach. […] The management of anterior compartment prolapse ranges from conservative treatments, such as pelvic floor muscle training and pessary use, to surgical intervention. […] Surgical repair options include anterior colporrhaphy and paravaginal repair, each of which addresses the structural defects causing the prolapse. […] In cases where the pelvic floor’s supportive structures weaken, leading to anterior prolapse, surgical management becomes crucial, with anterior colporrhaphy and paravaginal repair serving as key approaches.

• #55 Structural Failure Sites in Anterior Vaginal Wall Prolapse: Identification of a Collinear Triad

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5218807/

  This study indicates that vaginal attachment factors (apical and paravaginal) and measures related to the levator ani muscle—not the vaginal wall itself—are the factors most strongly associated with cystocele occurrence and size. […] The finding that the mean vaginal width was not greater in women with cystocele came as a surprise. Our data do not eliminate the possibility that certain women with cystocele have a wider than normal vagina, but it does show that factor as not being as important in determining anterior vaginal prolapse as others.

• #56 Structural Failure Sites in Anterior Vaginal Wall Prolapse: Identification of a Collinear Triad

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5218807/

  This study indicates that vaginal attachment factors (apical and paravaginal) and measures related to the levator ani muscle—not the vaginal wall itself—are the factors most strongly associated with cystocele occurrence and size. […] The finding that the mean vaginal width was not greater in women with cystocele came as a surprise. Our data do not eliminate the possibility that certain women with cystocele have a wider than normal vagina, but it does show that factor as not being as important in determining anterior vaginal prolapse as others.

• #57 Pathophysiology of Pelvic Organ Prolapse | IntechOpen

  https://www.intechopen.com/chapters/60935

  Pelvic organ support is provided by interaction between the pelvic floor muscle, ligaments and its connective tissues. […] Failure of anatomical support may result in pelvic organ prolapse. […] To appropriately treat these entities, comprehension of the various theories of the pathophysiology of pelvic organ prolapse is of paramount importance. […] A better understanding of pathophysiology of muscular, collagen, and neuronal components of the pelvic organs and their support would provide an insight of site specific defects and its prevention. […] Age has been recognized as an intrinsic factor in the development of pelvic floor dysfunction and most consensuses in favor that it has a role in the etiology of female pelvic organ prolapse (POP). […] The relative prevalence of POP increased by about 40% with every decade of life.

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