Cystocele

Preliminary Diagnosis: Cystocele

I. What imaging technique is first-line for this diagnosis?

• Fluoroscopic guided voiding cystourethrogram.

II. Describe the advantages and disadvantages of this technique for diagnosing cystocele.

Advantages

• Highly portable imaging modality.

• Highly sensitive and less specific in detailing and diagnosing a cystocele.

Disadvantages

• May expose patients to large amounts of ionizing radiation.

• Less adept in detailing the surrounding anatomical structures than other imaging modalities.

• Highly operator dependent.

III. What are the contraindications for the first-line imaging technique?

Contraindicated in pregnant patients.

IV. What alternative imaging techniques are available?

• Dynamic contrasted MR imaging

• Ultrasound

V. Describe the advantages and disadvantages of the alternative techniques for diagnosing cystocele.

Dynamic contrasted MR imaging

Advantages

• Does not expose patients to ionizing radiation.

• Offers more exquisite detail of the surrounding anatomical structures than other imaging modalities.

• Sensitive and specific in detailing and characterizing the primary abnormality and characterizing any secondary complications.

• Offers the best visualization of the pelvic floor and helps characterize and detail the surrounding anatomical structures.

Disadvantages

• Expensive.

• Time consuming.

• Requires significant patient cooperation to minimize motion artifact.

Ultrasound

Advantages

• Does not expose patients to ionizing radiation.

• Highly portable.

• May be used to guide treatment.

Disadvantages

• Highly operator dependent.

• Less adept in detailing the surrounding anatomical structures.

VI. What are the contraindications for the alternative imaging techniques?

Dynamic contrasted MR imaging

May be contraindicated in patients with non-MR compatible hardware.

Ultrasound

None.