Posterior bladder suspension defects in the female. A radiological classification with urodynamic and clinical evaluation.

Of 420 female patients examined by means of colpo-cysto-urethrography 51 patients presented posterior bladder suspension defects. Two distinct forms were seen:1. Trigonocele (22 patients)--a downward herniation of the trigone between the postero-inferiorly displaced vagina and the bladder neck, which is retained in a nearly normal position by muscle fibers from the pubococcygeal muscle and the pubovesical ligaments. Symptoms were mostly those associated with prolapse. Stress incontinence was rare, while urge incontinence, cystitis and retention of urine were seen. The morphology varied from cases where the herniation disappeared during detrusor contraction (compensated trigonocele) through typical forms to transitional forms between trigonocele and posterior bladder descent. 2. Posterior bladder descent (29 patients) comprises postero-inferior displacement of the vagina and bladder base together. Two subgroups are discernible: A. Bladder descent even at rest (16 patients). B. Bladder descent only during micturition (13 patients). Symptoms were varied, but stress incontinence was found in 31 per cent in group A, and 62 per cent in group B. Morphological forms varied from two cases that were normalized in position during detrusor contraction (compensated descent) to total prolapse during micturition.