Diagnostic Tests

Urodynamics

Symptoms of urinary incontinence and voiding dysfunction are common in women with advanced vaginal prolapse. Additionally, because significant anterior vaginal prolapse often results in urethral kinking that may mask underlying stress incontinence it is our practice to obtain preoperative urodynamics with vaginal packing or pessary placement to evaluate the lower urinary tract in these patients.

Magnetic Resonance Imaging

Single-shot turbo fast spin echo (SSFSE) dynamic magnetic resonance imaging (MRI) sequences can be useful to further define the nature of the prolapse and evaluate for potential enteroceles, rectoceles, or uterine prolapse. Many patients with severe anterior vaginal wall prolapse have defects in pelvic floor relaxation such that they are predisposed to formation of these other forms of prolapse. The MRI also allows simultaneous viewing of the distal ureters in order to demonstrate ureteral dilation that may accompany high-grade cystoceles with kinking of the trigone. This information is invaluable as a preoperative tool because it allows one to properly define the exact nature of the prolapse (see chapter Imaging of the Genitourinary Tract in Females).

Cystoscopy

Preoperative office cystoscopy is useful in the evaluation of the prolapse patient with lower urinary tract symptoms such as urinary urgency, hematuria, and obstructed voiding in order to detect concurrent bladder pathology. Additionally, we have found it useful to use a "light test" to more accurately differentiate a cystocele from other types of vaginal prolapse. This is performed during cystoscopy with the tip of the cystoscope aimed downward. Although this test is quite simple, it can yield important information as well.

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