Grade III cystocele and grade IV total uterine prolapse

Case contributed by Nikos Karapasias


Patient with pain in the right upper quadrant in combination with multiple episodes of vomiting and rigors with fever (39.1°C). Patient expresses that "something is protruding" from the vagina. US reports bilateral hydronephrosis and dilatation of ureters. The urinary bladder reported as “empty of urine”.

Patient Data

Age: 70 years
Gender: Female

Grade III cystocele (total type), the urinary bladder is abnormally positioned ~10 cm below the pubic symphysis, which severely affects the urinary system (bilateral hydronephrosis & dilated ureters) in combination with a grade IV (total) uterine prolapse (eversion).

Gynecological examination is consistent with grade IV total uterine prolapse (Baden-Walker halfway system).

The findings are confirmed with CT urography.

Case Discussion

Pelvic organ prolapse (POP), with bulging of one or more of the pelvic organs into the vagina, is a type of pelvic floor disorder.

About one-third of all women are affected by prolapse or similar conditions over their lifetime. Pelvic organ prolapse can affect the front, top or back of the vagina:

  1. Anterior prolapse (cystocele): the bladder bulges into the front wall of the vagina
  2. Prolapse of the cervix or top of the vagina: the cervix or uterus drops.
  3. Posterior wall prolapse (rectocele or enterocele): part of the bowel bulges forward into the back wall of the vagina.

It is possible to have more than one of these types of prolapse at the same time.

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