Cystocele and functional anatomy of the pelvic floor: review and update of the various theories

International Urogynecology Journal
Géry LamblinChrystèle Rubod

Abstract

We updated anatomic theories of pelvic organ support to determine pathophysiology in various forms of cystocele. PubMed/MEDLINE, ScienceDirect, Cochrane Library, and Web of Science databases were searched using the terms pelvic floor, cystocele, anatomy, connective tissue, endopelvic fascia, and pelvic mobility. We retrieved 612 articles, of which 61 matched our topic and thus were selected. Anatomic structures of bladder support and their roles in cystocele onset were determined on the international anatomic classification; the various anatomic theories of pelvic organ support were reviewed and a synthesis was made of theories of cystocele pathophysiology. Anterior vaginal support structures comprise pubocervical fascia, tendinous arcs, endopelvic fascia, and levator ani muscle. DeLancey's theory was based on anatomic models and, later, magnetic resonance imaging (MRI), establishing a three-level anatomopathologic definition of prolapse. Petros's integral theory demonstrated interdependence between pelvic organ support systems, linking ligament-fascia lesions, and clinical expression. Apical cystocele is induced by failure of the pubocervical fascia and insertion of its cervical ring; lower cystocele is induced by pubocervical...Continue Reading

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Citations

Jan 24, 2016·Updates in Surgery·Salvatore Giovanni VitaleSusanna Tarda
Jul 13, 2016·Archives of Gynecology and Obstetrics·Géry LamblinMichel Cosson
Dec 13, 2019·International Urogynecology Journal·Victoria AsfourVik Khullar
Feb 2, 2021·International Urogynecology Journal·Shahla Faal SiahkalMaryam Beheshti Nasab
Feb 8, 2018·American Journal of Obstetrics and Gynecology·Mitchell B BergerJohn O L DeLancey
Sep 29, 2021·The Australian & New Zealand Journal of Obstetrics & Gynaecology·Polina SchwarzmanAdi Y Weintraub

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