Preliminary Diagnosis: Cystocele

I. What imaging technique is first-line for this diagnosis?

  • Fluoroscopic guided voiding cystourethrogram.

II. Describe the advantages and disadvantages of this technique for diagnosing cystocele.

Advantages

  • Highly portable imaging modality.

  • Highly sensitive and less specific in detailing and diagnosing a cystocele.

Disadvantages

  • May expose patients to large amounts of ionizing radiation.

  • Less adept in detailing the surrounding anatomical structures than other imaging modalities.

  • Highly operator dependent.

III. What are the contraindications for the first-line imaging technique?

Contraindicated in pregnant patients.

IV. What alternative imaging techniques are available?

  • Dynamic contrasted MR imaging

  • Ultrasound

V. Describe the advantages and disadvantages of the alternative techniques for diagnosing cystocele.

Dynamic contrasted MR imaging
Advantages

  • Does not expose patients to ionizing radiation.

  • Offers more exquisite detail of the surrounding anatomical structures than other imaging modalities.

  • Sensitive and specific in detailing and characterizing the primary abnormality and characterizing any secondary complications.

  • Offers the best visualization of the pelvic floor and helps characterize and detail the surrounding anatomical structures.

Disadvantages

  • Expensive.

  • Time consuming.

  • Requires significant patient cooperation to minimize motion artifact.

Ultrasound
Advantages

  • Does not expose patients to ionizing radiation.

  • Highly portable.

  • May be used to guide treatment.

Disadvantages

  • Highly operator dependent.

  • Less adept in detailing the surrounding anatomical structures.

VI. What are the contraindications for the alternative imaging techniques?

Dynamic contrasted MR imaging

May be contraindicated in patients with non-MR compatible hardware.

Ultrasound

None.

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