Cystocele - Urologist | UC Irvine Department of Urology

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A cystocele is the medical term for a prolapsed bladder.

A cystocele is somewhat similar to a hernia but occurs between the bladder and vagina. When the wall between the bladder and vagina weakens, the bladder can drop into the vagina. In a more severe prolapse, the bladder can even drop further so that it is protruding out of the vagina.

In the past, a cystocele was normally fixed by insertion of surgical mesh. Since the year 2008, however, the FDA has issued warnings about the long-term effects of using mesh for any pelvic organ prolapse.
Instead, doctors are devising new and safer ways to fix these problems.

What Causes a Cystocele?

There are many muscles and tissues supporting the bladder, uterus, and vagina. Over time, these muscles and tissues can weaken. Women who have birthed children, especially if they have had several, are more likely to have a weakening of those tissues. Age and genetics can also contribute to the problem, as well as heavy lifting and chronic constipation.

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How Can a Cystocele be Treated?

Non-surgical interventions such as physical therapy and the reduction of heavy lifting may be attempted first if the prolapse is not severe. When the prolapse is severe or does not resolve with other interventions, surgery is recommended.

In the past, a piece of surgical mesh was often inserted in between the bladder and the vagina. This worked well in some patients to prevent the bladder from falling into or out of the vagina. However, future problems with the mesh were not foreseen at the time and the mesh has been proven to cause complications. After reviewing research done from 1996-2011, the FDA classified surgical mesh for pelvic organ prolapse as a Class III medical device. This is the most stringent of the FDA’s classifications.

Many doctors have had success using sutures to fix the prolapse. These sutures have held up well and not required further surgery down the road. For patients who already have surgical mesh implanted, surgeons will often remove the mesh first and then repair the prolapse with interlocking sutures.

Why are Sutures a Better Choice than Mesh?

Some patients may insist on using surgical mesh to treat their cystocele, based on previous medical opinions and recommendations from friends and family. Although serious complications are not common with the mesh, the mesh has been shown to cause the following problems:

Pain with sexual intercourse
Pain in the legs, abdomen or buttocks
Widespread pelvic and vaginal pain
Inability to walk

These complications are not immediately apparent but may turn up years after the surgery is performed. Over time, the vaginal tissue can begin to atrophy. This can lead to ulcers in the vaginal wall, allowing the mesh to poke through.

Treatment for cystocele has improved over the years. Using sutures instead of mesh can reduce the possibility of the patient having long-term complications.