The traditional radiological classification of cystoceles, originally proposed by Green, is based on
----1. descent of the bladder neck,
---- 2.retrovesical angle—the angle between the proximal urethra and
---- 3.the trigonal surface of the bladder —and the degree of urethral rotation.
-----Green type I is described as cystocele with open retrovesical angle (≥ 140°) and urethral rotation < 45°.
------ Green type II describes a cystocele with open retrovesical angle (≥ 140°) and urethral rotation between 45 and 120°, also called cystourethrocele.
------A cystocele with intact retrovesical angle (< 140°) is defined as Green type III.
----1. descent of the bladder neck,
---- 2.retrovesical angle—the angle between the proximal urethra and
---- 3.the trigonal surface of the bladder —and the degree of urethral rotation.
-----Green type I is described as cystocele with open retrovesical angle (≥ 140°) and urethral rotation < 45°.
------ Green type II describes a cystocele with open retrovesical angle (≥ 140°) and urethral rotation between 45 and 120°, also called cystourethrocele.
------A cystocele with intact retrovesical angle (< 140°) is defined as Green type III.
Both cystourethrography and ultrasound can distinguish between two main types of cystocele, i.e. cystourethrocele (Green type II) and cystocele with intact retrovesical angle (Green type III)
----. For this purpose, translabial ultrasound seems particularly useful since it is non-invasive and can easily identify not just the bladder, but also surrounding soft tissues, allowing assessment of bladder neck descent, retrovesical angle and degree of cystocele descent.
------. These two types of cystocele may have different etiologies and functional implications. Cystocele type III is more likely to be associated with levator trauma, i.e. avulsion injury, which is due to childbirth, associated with prolapse and prolapse recurrence
----. A Green type II cystocele is more commonly found in patients with stress incontinence and an intact levator
-----. Women with a Green type III cystocele tend to suffer more from voiding dysfunction than stress incontinence. The etiology of cystourethrocele is less likely to be caused by paravaginal defects than is the type III cystocele
----. For this purpose, translabial ultrasound seems particularly useful since it is non-invasive and can easily identify not just the bladder, but also surrounding soft tissues, allowing assessment of bladder neck descent, retrovesical angle and degree of cystocele descent.
------. These two types of cystocele may have different etiologies and functional implications. Cystocele type III is more likely to be associated with levator trauma, i.e. avulsion injury, which is due to childbirth, associated with prolapse and prolapse recurrence
----. A Green type II cystocele is more commonly found in patients with stress incontinence and an intact levator
-----. Women with a Green type III cystocele tend to suffer more from voiding dysfunction than stress incontinence. The etiology of cystourethrocele is less likely to be caused by paravaginal defects than is the type III cystocele
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