, Volume 15, Issue 1, pp 3-9
Date: 20 Dec 2003

Diagnosis of cystocele – the correlation between clinical and radiological evaluation

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In patients with genital prolapse involving several compartments simultaneously, radiologic investigation can be used to complement the clinical assessment. Contrast medium in the urinary bladder enables visualization of the bladder base at cystodefecoperitoneography (CDP). The aim of the present study was to evaluate the correlation between clinical examination using the Pelvic Organ Prolapse Quantification system (POP-Q) and CDP. Thirty-three women underwent clinical assessment and CDP. Statistical analysis using Pearson’s correlation coefficient (r) demonstrated a wide variability between the current definition of cystocele at CDP and POP-Q (r=0.67). An attempt to provide an alternative definition of cystocele at CDP had a similar outcome (r=0.63). The present study demonstrates a moderate correlation between clinical and radiologic findings in patients with anterior vaginal wall prolapse. It does not support the use of bladder contrast at radiologic investigation in the routine preoperative assessment of patients with genital prolapse.

Editorial Comment: The authors attempt to correlate the visceral position of the bladder on fluoroscopy to the anterior vaginal wall measurements on POP-Q examination. Consistent with other published reports, they show only moderate statistical correlations. Clinically, the correlations are probably not useful. Thirty-eight percent of women with radiographic cystoceles had no clinically significant prolapse (stage III or IV). Based on their findings the authors conclude that the routine use of radiologic investigation might not be warranted in the preoperative assessment of women with pelvic organ prolapse. This must be interpreted with caution when generalizing their data to all women with prolapse. Only 17% of the women in this study had had prior pelvic surgery. The authors also do not address how cystodefecoperitoneography results affected the diagnosis of enterocele or rectocele. Other authors have shown a significant increase in enterocele diagnosis using cystodefecoperitoneography.