Spontaneous reduction of bladder base prolapse with gradual filling: A video-urodynamic observation

OBJECTIVE: To report video-urodynamic observations on the effect of gradual bladder filling on the degree of bladder base prolapse while erect, as the effect of bladder fullness on the degree of bladder base descent in patients with a cystocele has rarely been addressed. PATIENTS AND METHODS: Thirty-six consecutive patients with complaints of a protruding vaginal mass due to bladder prolapse underwent video-urodynamic studies, comprised of filling and voiding cystometry with contrast material, while standing. RESULTS: During filling cystometry, in 16 of 36 patients (44%) the prolapse gradually and spontaneously reduced with increasing bladder volumes, so that at cystometric capacity the bladder base was completely reduced. Straining at cystometric capacity did not affect the bladder base position and, during voiding cystometry, the bladder base remained completely reduced. In the remaining 20 patients there was only partial reduction of the cystocele during bladder filling, i.e. the cystocele was reduced by half or less. Seven of the 16 patients with a full reduction of cystocele had concurrent uterine prolapse, compared with 15 of 20 (80%) who had only partial or no spontaneous reduction; the difference was statistically significant (P = 0.02). CONCLUSION: These video-urodynamic results suggest that when erect the degree of bladder base descent is volume-dependent, and that concomitant uterine prolapse might hinder spontaneous reduction of the cystocele.