Grade 2 or 3 cystocele can be diagnosed through symptoms and vaginal exam where the bladder reaches or protrudes through the vaginal opening. Further tests like cystogram, pelvic fluoroscopy, MRI, or urodynamics can provide more detail on cystocele and urinary problems by visualizing soft tissues and measuring bladder function and residual urine. Cystocele occurs when the pubocervical fascia is attenuated, causing the bladder to bulge into the anterior vaginal wall.

3.  We may be able to diagnose a grade 2 or
grade 3 cystocele from a description of the
symptoms and physical examination of the
vagina.
1. grade 1 (mild) : The bladder protrudes only to the upper (internal) vagina
2. grade 2(moderated) : The bladder reaches the vaginal opening
3. grade 3 (most advanced) : The bladder bulges directly through the vaginal
opening

4. We may press a speculum against the vaginal side walls and ask the
individual to straincystocele will seen bulging into the anterior vaginal
wall.
The central cystocele results from attenuation or separation of the
pubocervical fasciaprotrusion will results in the classic appearance of a
loss of the rugae or vaginal
The fallen part of the bladder may be visible upon examination of the vagina;
a smooth, bulging mass will be seen below the level of the cervix

7.  If a woman has difficulty emptying her
bladder, we may measure the amount
of postvoid residualwith a bladder
ultrasound or use a catheter to measure
the amount of remaining urine.

8. 1. Voiding Cystourethrogram
2. Pelvic floor fluoroscopy
3. Magnetic resonance imaging (MRI)
4. Urodynamic testing
5. Fluoroscopic examination
(cinefluorography)
6. Cystometry measures bladder
capacity and control
7. Uroflowmeter

9. 1.Voiding Cystourethrogram
 A woman gets a voiding
cystourethrogram while urinating.
 The x-ray images show the shape of
the woman’s bladder to see any
problems that might block normal
urine flow.

10.  In such circumstances, an upright resting
and straining cystogram can be helpful
in determining the presence and degree
of cystocele.

11. 2. Pelvic floor fluoroscopy
To measures perineal descent, helping to
determine which organ has herniated into
the vagina: it is especially useful if problems
with defecation have been reported.
3. Magnetic resonance imaging (MRI)
can reveal similar information, and has the
added advantage of allowing Cystocele
visualization soft tissue of the pelvic floor in
greater detail.

12. 4. Urodynamic testing
is performed if incontinence accompanies pelvic
organ prolapse.This testing involves taking x-rays
of the bladder during urination (voiding
cystourethrogram) to reveal the shape of the
bladder and problems that might block the normal
flow of urine.
5. Fluoroscopic examination (cinefluorography)
while voiding, may be needed to rule out bladder
abnormalities and other problems in the urinary
system
6. Cystometry measures bladder capacity and
control
7.Uroflowmetery