Case contributed by Jemie Koon
Diagnosis certain


Urinary hesitancy. Initial ultrasound shows an anechoic focus immediately inferior to the urinary bladder.

Patient Data

Age: 88 years
Gender: Female

Patient post total abdominal hysterectomy and bilateral salpingo-oopherectomy.

There is prolapse of the posterior urinary bladder floor at the level of the vagina, mildly indenting and displacing the urethra anteriorly. Fluid signal is at this level, measuring 1.7 x 1.3 x 1.1 cm.

Focal outpouching noted in the superior bladder wall, measuring 0.9 x 0.8 cm, and likely pertaining to a small urachal diverticulum.

Case Discussion

A cystocele occurs when the bladder descends inferiorly towards the vagina and perineum. This happens when the wall between the bladder and the anterior vaginal fascia weakens. Depending on the degree of descent, prolapse can be graded as Grade I (level of vagina), Grade II (level of vaginal introitus), and Grade III (perineum through the vaginal opening). Some of the risk factors include pregnancy and childbirth, age, and repetitive straining.

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