ABSTRACT
A cystocele is defined as anterior vaginal wall (bladder) prolapse into the vagina, with or
without urethral hypermobility. Cystoceles have been described by several different classifi-
cation systems, and most commonly categorized by the degree of bladder descent and ana-
tomic defect as in the Baden and Walker classification (1) (Table 1). More recently the
International Continence Society (ICS) has accepted standardization of the terminology for
pelvic organ prolapse quantification (POP-Q) (2). Using POP-Q, both the stages III (Ba)
and IV (C, D) would be classified as grade IV cystoceles, according to the traditional nomen-
clature (Table 2). However, it is rare to see an isolated stage III or IV cystocele without
concurrent pelvic organ prolapse. The focus of this chapter is the pathophysiology, diagnosis,
and surgical treatment of severe bladder prolapse, which for simplicity will be referred to as
stage IV cystocele.
