A clinical and urodynamic study of patients with varying degrees of cystocele

To assess urodynamic alterations in patients with varying degrees of cystocele but without prolapse of the uterus, rectocele and/or enterocele.

Between September 1993 and June 1995 we examined 83 patients with varying degrees of isolated cystocele. All subjects were questioned about their medical history and underwent urogynaecological examination and urodynamic tests.

In our study there were no cases of pure urge incontinence nor were there any normal urodynamic situations; genuine stress incontinence was the most frequent urinary disorder. Moreover patients with grade 3-4 cystocele on the Baden-Walker scale had more difficulty in voiding than subjects with milder forms of cystocele. In fact the maximum and average flow rates of the former tended to decrease, flow and voiding times were longer and acceleration of flow rate were significantly lower. The maximum urethral closure pressure tended to diminish with an increase in the duration of menopause, whereas the pressure transmission ratio tended to decline significantly with an increase in cystocele severity. In conclusion, even when cystocele is the only alteration in pelvic statics, it determines significant urodynamic changes that must be carefully assessed so as to optimize the choice, mode and time of surgical, rehabilitative or pharmacological intervention.