Cystocele

　　The occurrence of cystocele mainly occurs during labor, when the fetal head passes through the vagina, the pubic bladder cervix fascia and the anterior vaginal wall bladder supporting tissue on both sides are overstretched or torn. Especially in the second stage of labor, when the cervix is fully dilated, the bladder is full, and labor or vaginal surgery assistance such as forceps delivery, vacuum extraction, breech extraction, etc. can further damage the supporting tissue at the bottom of the bladder, and if physical labor is started too early during the puerperium, the vaginal supporting tissue cannot return to normal. Therefore, cystocele often occurs in multiparous women, and is extremely rare in primiparous women.

　　The supporting tissue of the anterior vaginal wall is mainly the pubic bladder cervix fascia. During labor, when the fetal head passes through the vagina, the pubic bladder cervix fascia and the pubic coccygeal muscle are inevitably extremely stretched, even torn, especially if the rest is not good before the puerperium, especially if physical labor is started too early.

　　1. Abnormal development and underdevelopment of the bladder

　　The absence of bladder development is often accompanied by renal agenesis, so there are very few survivors. In a group of 19,046 post-mortem data, there were 7 cases. There are 25 cases in the literature. Underdeveloped bladder refers to retaining the cloaca, caused by the septal obstruction of the urachus. The ureters terminate in the rectum.

　　2. Duplicated bladder

　　It is the result of embryonic developmental disorders, caused by a part of the embryonic tail being affected, often accompanied by posterior intestinal duplication. It can be divided into left and right, anterior and posterior, or upper and lower two bladders, gourd-shaped or polycystic bladder. In a group of 18 cases, 50% were accompanied by lower gastrointestinal duplication anomalies, and in a group of 20 cases with posterior intestinal duplication anomalies, 60% had duplicated bladders. The incidence of duplicated external genitalia is also high. Urinary tract obstruction and infection symptoms may occur, and a treatment plan must be formulated after a comprehensive examination based on the condition of the bladder lesions and other specific congenital anomalies of the organs, including relieving urinary tract obstruction, preserving bladder function,整形 and correcting gastrointestinal anomalies.

　　3. Bladder diverticula

　　Due to the presence of congenital localized weaknesses in the bladder wall, and the presence of obstructive factors in the lower urinary tract during fetal development, the intravesical pressure increases, causing the bladder wall to protrude between the detrusor muscle bundles, forming diverticula. However, there may also be no anatomical obstruction at the bladder neck and urethra. Therefore, its formation is related to the abnormal arrangement of bladder muscle fibers. It is more common in males and is often solitary, most located near the ureteral orifice. After the formation of the diverticula, they become increasingly filled and enlarged with each urination, eventually leading to the ureter being pulled into the diverticulum, causing the disappearance of the submucosal segment and the interstitial segment of the oblique ureter, resulting in vesicoureteral reflux. Bladder diverticula are often discovered during further urological examination due to urinary tract infection or difficulty urinating. Diagnosis mainly relies on urography, which can show the shape and position of the bladder diverticula. Bladderoscopy may be supplemented when necessary. Treatment mainly involves relieving lower urinary tract obstruction, controlling infection, and performing diverticulectomy, or adding a urinary bladder-ureteral reanastomosis to prevent reflux.

　　4. Bladder exstrophy

　　Bladder exstrophy and urethral cleft complex deformity is caused by developmental abnormalities during the 4th to 10th weeks of embryogenesis. Due to the excessive development of the cloacal membrane, it blocks the migration of mesenchymal tissue and the normal development of the lower abdominal wall. The time and location of the rupture of the cloacal membrane are different, leading to a series of deformities from penile-type urethral cleft to cloacal exstrophy. The typical bladder exstrophy is only a part of this type of deformity, accounting for about 50%, with an incidence rate of about 1 in 10,000 to 50,000 newborns, twice as common in males as in females. The risk of exstrophy in their offspring is 500 times higher than that in the general population, but the genetic type has not been determined yet.

　　Mild cases may show no symptoms or only mild symptoms such as a sense of dropping, backache, which worsens after prolonged standing, and decreases after rest in bed. Severe cases, in addition to the sense of dropping, often have difficulty urinating and a large amount of residual urine, frequently accompanied by urinary tract infections. If the internal sphincter of the urethra is also relaxed, urine leakage can occur during activities that increase abdominal pressure such as laughing, coughing, or exertion, known as stress urinary incontinence.

　　1. Stage Ⅰ:The prolapsed bladder is still located inside the vagina, lower than the normal anatomical position; Stage Ⅱ refers to the protruding part of the bladder being visible outside the vaginal orifice when exerting force.

　　2, III degree:It refers to the exposure of the cystocele part to the outside of the vaginal orifice at rest;

　　3, IV degree:It refers to the complete prolapse of the anterior vaginal wall to the outside of the vaginal orifice, even beyond the labia majora.

　　Properly handle childbirth. For those with cephalopelvic disproportion, cesarean section should be performed early; the mother should not exert downward force when the cervix is not fully dilated; when the cervix is fully dilated, perineal incision should be performed in time, and cesarean section may be performed to assist delivery if necessary, to avoid prolongation of the second stage of labor; if perineal laceration occurs, it should be repaired immediately; avoid premature physical labor after childbirth; postpartum health exercises help to restore the tension of the pelvic floor muscles and fascia.

　　Vaginal palpation, colposcopy, transvaginal ultrasound.

　　Vaginal colposcopy is the use of a microscope to enlarge the cervical or genital epithelial tissue,配合光源及滤镜之作用，clearly inspect the cervix and genitals, allowing the doctor to observe the changes in the cervical epithelium and blood vessels to diagnose whether there are abnormal changes, and at the same time determine the severity of the lesion.

　　Pay attention to supplementing nutrition in diet. Rational dietary habits: Maintain a light diet. Eat more fresh vegetables and aquatic products. Such as green vegetables, radish, kelp, nori, etc. It is advisable to eat less and more meals. Avoid eating fatty meats and animal internal organs. Do not eat strong刺激性 foods such as scallions, peppers, coffee, etc. Eat less refined sugar, honey, fruit sugar, pastries, etc.

　　Mild cases only need to pay attention to appropriate nutrition and anal contraction exercises. Severe cases require vaginal wall repair. Severe and symptomatic cases should undergo anterior vaginal wall repair surgery to restore the prolapsed bladder to its normal anatomical position. The key to the surgery is to return the prolapsed tissues and organs to their original position and to fix the bladder at a higher position to strengthen its support for the bladder. Those with自觉symptoms but not suitable for surgery due to other chronic diseases should strengthen nutrition, avoid prolonged standing and heavy physical labor, and avoid overfilling of the bladder. Regularly perform pelvic floor muscle exercises. Vaginal pessary can temporarily alleviate the patient's discomfort and allow for smooth urination, disappearance of inflammation, but it must be inserted in the morning and removed before bedtime. To avoid secondary infection or the formation of fistulas due to long-term pressure from foreign bodies.