Estimation of bladder wall thickness at different areas with ultrasound and its relation to cystocele

Abstract

Objective The aim was to verify our hypothesis that decreasing bladder wall thickness will facilitate ballooning of the bladder wall at this thin part that will be involved in a process of cystocele other than the last traditional reported factors. Patients and methods This prospective study included 80 female patients between 20 and 45 years of age who were divided into two groups. Group I: 40 women were normal (control group); 20 of them were married and 20 were virgins and Group II: Comprising 40 patients have clinical manifestations of cystocele. All underwent complete history taking, physical examination, translabial, and transabdominal ultrasound examination with measurement of anterior and posterior detrusor wall thickness (DWT); also multichannel urodynamic testing was done to diagnose if there is associated obstruction or not. Results In group I, the mean DWT in 20 virgin women was 3.28±0.79 at the anterior bladder wall and 2.72±0.77 at the posterior bladder wall by transabdominal ultrasound, whereas by translabial ultrasound it measured 3.34±0.83 at the anterior bladder wall and 2.62±0.94 at the posterior bladder wall. In 20 married women of the control group without cystocele the mean DWT was 2.85±0.72 and 2.70±0.75 at the anterior and the posterior bladder wall, respectively, by transabdominal ultrasound. Also, the mean DWT was 2.90±0.69 and 2.75±0.74 at the anterior and the posterior bladder wall, respectively, by translabial ultrasound. In group II the anterior and the posterior wall measured 2.95±0.95 and 2.25±0.73, respectively, by transabdominal ultrasound, while it measured 4.35±1.40 and 2.40±0.77, respectively, by translabial ultrasound. With obvious obstruction in group II, P det.Q max. was 29.18±7.54 whereas it was 18.10±13.40 in group I. An increased level of Q max was noticed in group I with a mean value of 25.73±8.56 whereas it was of a less value in group II (15.83±6.21). Conclusion Our findings verify our hypothesis that decreasing bladder wall thickness will facilitate ballooning of the bladder wall at this thin part. Moreover, an increase in intravesical pressure during micturition will form a pseudo-diverticulum of the bladder wall, which in turn had lost the scaffolding of the fascia and/or vaginal wall.