Presentation
This patient was referred to radiology unit for abdominal ultrasound with complaints of abdominal discomfort.
Patient Data
Antero-posterior diameter of bladder was increased due to elongation and gradual narrowing of the posterior portion of the bladder on transabdominal US (note the funnel shaped bladder = funnelization of the bladder).
It was upon this observation during the USG examination that the patient admitted to having stress incontinence when questioned further. It is interesting to note that such complaints, probably due to the cultural background (shyness), are usually hidden from their primary physicians.
The white marks depict a funnel shaped bladder.
The yellow circular intermittent lines depicts a normal shaped bladder border while the red continuous line shows herniated bladder neck.
Case Discussion
Small cystoceles are usually asymptomatic but may be associated with stress urinary incontinence. Large cystoceles may predispose to obstructive voiding symptoms and rarely to unilateral or bilateral hydronephrosis with potential impairment in renal function.
On transabdominal US in the oblique transverse plane, the anterior-posterior diameter of the bladder is increased because of elongation and gradual narrowing of the posterior portion of the bladder in patients with small cystoceles. This may be termed funnel-shapedd bladder or funnelization of the bladder. In addition, in patients with large cystoceles, the distal ureter, ureterovesical junction and bladder neck may not be demonstrated on transabdominal USG due to the descent of the bladder neck; this may also be called unfinishable bladder.
In conclusion, knowledge of transabdominal ultrasonographic findings of cystocele is important in view of the fact that patients often do not seek medical attention for this symptom because of shyness. Knowledge of such problems can help in directing diagnosis and better management which will in turn lead to prevention of further renal damage.
Unable to process the form. Check for errors and try again.