1. Urodynamic investigation in women with stress urinary incontinence and cystocele Gordon Hosker The Warrell Unit, St Mary’s Hospital, Manchester. UK.

2. ä Cystocele can change the anatomical relationship between the bladder and the urethra

4. Green - Type I

5. Green – Type I

6. Green - Intermediate

8. Green – Type II

10. Filling cystometry ä Prolapse can mask incontinence. ä During filling cystometry, if no incontinence is seen, carefully reduce the prolapse with a finger, speculum, or pessary and repeat the stress test.

11. Voiding cystometry ä Prolapse can kink the urethra. ä This gives the appearance of obstructed voiding on pressure/flow studies.

12. Normal pressure-flow

13. Outflow obstruction

14. Detrusor Overactivity ä More prevalent in large cystocele compared to moderate cystocele ä Some resolution with prolapse surgery? Romanzi et al, 1999 Golomb et al, 2006 Nguyen et al, 2001

15. Other factors affecting anatomical relationships  Not only are anatomical relationships influenced by the size of the cystocele itself, they can be affected by:  Degree of bladder fullness  Patient position  Other prolapse (e.g. uterine prolapse)

16. Recent review Clinical relevance of urodynamic investigation tests prior to surgical correction of genital prolapse: a literature review Roovers and Oelke Int Urogynecol J (2007) 18 455-460 Int Urogynecol J (2007) 18 455-460