Ultrasound allows us to easily differentiate between two types of cystocele, depending on whether the retrovesical angle is modified (3).
- Cystourethrocele, which occurs with an open retrovesical angle, is usually accompanied by urethral hypermobility and stress urinary incontinence. It will rarely present with a voiding dysfunction.
- The opposite occurs when there is cystocele with an intact retrovesical angle, which is more associated with a levator ani injury and therefore often seen in cases of more severe prolapse. This, in addition, usually occurs with a voiding dysfunction due to urethral kinking (the prolapsed structure rides on top of the urethra and compresses it, making it difficult to empty) but without stress urinary incontinence.
Figure 2. The image on the left shows a cystocele whose retrovesical angle increases with stress, and the image on the right depicts a cystocele with a preserved angle