In uterovaginal prolapse there is damage to, or weakness of, the structures which support the pelvic organs, so that some of these descend from their normal positions and fmally herniate through the vaginal opening. Certain terms may fIrst be defined (Fig. 10.1).
Cystocele
Prolapse of the bladder and anterior vaginal wall is known as a cystocele. Descent of the urethra and bladder neck may occur separately or accom. pany a cystocele; when sagging of the urethra occurs alone it is sometimes known as a urethrocele.
Rectocele
Prolapse of the rectum and posterior vaginal wall is known as a rectocele. It is usually accompanied by some deficiency of the perineal body.
Uterine prolapse
Prolapse of the uterus is accompanied by descent and inversion of the’ vaginal vault. Three degrees of uterine prolapse are described: (1) the uterus becomes retroverted and descends in the axis of the vagina though; the cervix does not reach the introitus; (2) the cervix appears at or pro-j trudes from the vaginal orifice; (3) the vaginal walls are everted to such a degree that the uterus lies outside the vulva; this complete form of uterine prolapse is known as procidentia.
Cystocele or rectocele or both may occur without uterine descent, but uterine prolapse is accompanied by descent of the bladder because of the close attachment of the bladder to the anterior aspect of the supravaginal cervix. Descent of the rectum does not necessarily accompany uterine prolapse because the prolapsing vaginal wall easily becomes separated from the rectum.
Enterocele
A hernia of the rectovaginal peritoneal pouch through the posterior vaginal fornix is known as an enterocele. Elongation of the rectovaginal pouch inevitably accompanies uterine prolapse, and small intestine may be found in the peritoneal sac behind the uterus in cases of procidentia. Enterocele may also occur without uterine prolapse, and cause a bulge of the upper part of the posterior vaginal wall which must be distinguished from a
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