03.09.2014

Цистоцеле

Цистоцеле - это заболевание, при котором вследствие опущения передней стенки влагалища происходит смещение мочевого пузыря. Данная патология наиболее часто встречается у женщин после сорока лет. 

Причины развития цистоцеле

Основной причиной образования цистоцеле, как правило, может быть родовая травма с разрывами промежности. Так же возникает цистоцеле от сильного физического напряжения при подъеме тяжестей, при хронических запорах, во время родов у тех, кто неоднократно рожал естественным путем. Чаще всего цистоцеле встречается у пожилых женщин. 

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Технология развития цистоцеле представляет собой цепочку взаимосвязанных факторов — выпячивание передней стенки влагалища происходит из-за растяжения связочного аппарата диафрагмы малого таза и гипертрофии мышечных слоев тазового дна. Вместе с выпячиванием передней стенки влагалища смещается шейка мочевого пузыря и укорачивание мочеиспускательного канала. Совокупность этих факторов приводит к тому, что возникает затруднение мочеиспускания и стрессовое неудержание мочи, возможно до полного недержания. 

Симптомы цистоцеле

Основными симптомами заболевания являются: 
  • при долгом стоящем положении тела ощущается давление и тяжесть внизу тазовой области и влагалища;
  • дискомфорт при физической нагрузке и кашле; 
  • ощущение неполного опорожнения мочевого пузыря; 
  • непроизвольное мочеиспускание во время чихания, смеха и кашля; 
  • боль при мочеиспускании и во время полового акта; 
  • выпячивание ткани через влагалищное отверстие размером с грецкий орех. 
При легкой форме цистоцеле, выпячивание незначительное и его сложно обнаружить. 

Диагностика

Диагноз цистоцеле устанавливается основываясь на результатах осмотра с помощью гинекологических зеркал передней стенки влагалища и половой щели. Во время осмотра выявляется выпячивание передней стенки влагалища, которое увеличивается при напряжении передней стенки живота. 

В тяжелых случаях выпячивание может при нахождении больной в вертикальном положении располагаться вне половой щели и достигать больших размеров. В полости цистоцеле иногда находят мочевые камни у женщин пожилого возраста. При вертикальном положении больной, на цистограмме тень мочевого пузыря проецируется на фоне костей лонного сочленения или ниже его.

Лечение цистоцеле

Лечение, как правило проводят в условиях стационара, его цель заключается в том, чтобы восстановить анатомическое соотношение стенок мочевого пузыря и влагалища. А также хирургическое восстановление мочеиспускания. Главным оперативным методом считается  кольпорафия, которая способствует укреплению дна мочевого пузыря и его шейки. Женщинам старшего возраста рекомендуется носить пессарии. 
 
При легкой и умеренной форме цистоцеле обычно рекомендуется самостоятельный уход и консервативная терапия. В более тяжелых случаях применяется оперативное лечение.

При повторении цистоцеле, возможно, потребуется еще одна операция, но положительный результат уже не гарантируется.


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