TsISTOTsYoLE (cystocele; Greek kystis a bladder + kele a tumor) — protrusion and shift down of a wall of a bladder is preferential in his neck and a vesical triangle, arisen owing to omission of a front wall of a vagina.
C. usually occurs at women 40 years are more senior. Emergence of C. it is caused by hl. obr. disturbance of an integrity or atrophy of muscles, destruction of the copular device of an urinogenital diaphragm. The main reasons — a birth trauma, a heavy exercise stress. A part is played by reduction of quantity of a fatty tissue of a basin, especially near - cervical. As a result the back wall of a bladder and a front wall of a vagina lose the support, as leads to development of C. Under unfavorable conditions of C. increases, sometimes reaching the big sizes.
C. it is shown by the complicated urination, at a physical tension — an incontience of urine. Patients note protrusion of a vagina, quite often have pressure sense and raspiraniye (see the Prolapse of the uterus, vaginas). The bladder is pererastyanut, its sokratitelny ability is reduced, there is a residual urine in number from 20 — 30 to 100 ml and more. Approximately at 60 — 70% of patients with the tsistotsel recurrent cystitis (see), formation of urinary stones and emergence of a puzyrnomochetochnikovy reflux is observed (see).
Diagnosis of C. does not represent difficulties. At survey of a vagina by means of mirrors on its front wall the protrusion increasing at a natuzhi-vaniye and which is easily set is defined; at the big sizes C. at the time of its reposition the desire to an urination appears. Volume of C. increases at an exercise stress, walking. At rest of C. disappears. The metal catheter entered into a bladder is probed through a wall of a vagina in the place of protrusion; in cases when protrusion is not connected with the tsistotsel, napr, at a paraurethral cyst, the catheter is not probed.
Treatment operational. As the indication to operation often serves not size C., and expressiveness of symptomatology. The main method of operation is the front colporrhaphy (see).
The forecast after operational treatment in most cases favorable.
Bibliography: D z N e l and d z e A. G. Pato
logiya and therapy of shifts of bodies of a small pelvis of the woman, Tbilisi, 1963; To and D. V N. Guide to obstetric and gynecologic urology, page 348, M., 1978; M and -
and A. M c. Operational uroginekologiya, L., 1964; Gynecologic and obstetric urology, ed. by H. J. Buchsbaum a. J. D. Schmidt,
tz. 162, Philadelphia, 1978; To r e m 1 i n g H., Zutzeyer W. u. Heintz R. Gyna-kologische Urologie und Nephrologie, S. 244, Miinchen, 1977; M about 1 n y r G., M o h with si L. u. JonaG. Pathologische Veran-derungen an den oberen Harnwegen bei Uterusvorfall, Z. Urol., Bd 60, S. 445, 1967. D. V. Kan.