Cystocele is a hernia of the anatomical form of pelvic-genital prolapse, defined as: bladder through the anterior wall of the vagina [1] . This hernia reflects the failure of the support and suspension systems of the female pelvic organs [1] [2] . It is a truly functional pathology, resulting in a loss of confidence in the woman, a feeling of being less attractive physically and sexually, and an altered self-image [3] . Its clinical expression can be summed up as dysuria, urinary incontinence, pollakiuria, sexual problems, discomfort and a feeling of organ loss. The treatment of cystocele involves two groups of surgical techniques which differ in their approach. The upper approach involves promontory fixation and the vaginal approach, which offers the choice of autologous or prosthetic surgery [4] . This study finds its originality insofar as this way of approach is not in our current practice. Also we wish to draw the attention of the urologists of the Ivory Coast and those elsewhere of the interest and especially the elegance for both the patient and the surgeon. We report the results of the cure of cystocele by the vaginal route in 5 cases at the University Hospital of Bouaké.

Cystocele can affect women of all ages. However, physiological ageing and the menopause are considered to be major factors associated with genital prolapse in general and cystocele in particular [5] [6] . In their respective studies, Cosson, Bader and Jin Long reported a mean age of 69, 63 and 61.7 years [5] [6] [7] . In our study, the mean age of patients was 46 years, with extremes of 32 and 63 years. This result is similar to that of Diabaté in Senegal and Coulibaly in Mali, who reported an average age of 42 and 48 years respectively [4] [8] . Our result could be explained by the social demographic factors in our country (dystocial delivery, early childbearing and multiparity). Vaginal swelling (4/5) was the most common reason for consultation in our study, with stress urinary incontinence the most common [8] [9] [10] . Our result could be explained by the long evolution of cystocele, which accounts for the delay in consultation by patients. Cystocele is an anatomical form of pelviogenital prolapse in which the anterior wall of the vagina is herniated as a result of varying degrees of failure of the pelvioperineal support structures. The literature describes congenital risk factors, multiparity, dystocial delivery and trophic changes during the menopause [4] [8] [9] [10] . In our study, 4 patients had a history of dystocial delivery for fetal macrosomia and one patient was postmenopausal. We can explain the occurrence of cystoceles in our patients by ligament elongation on the one hand and muscle tear on the other during vaginal delivery of macrosomia. The clinical and physical symptoms of cystocele are well known in the literature. In our study, 4 patients presented with vaginal swelling and another with vulvar swelling. Cystocele was classified grade II in 4 patients and grade III in one patient. This finding could be explained by the delay in consultation. From a therapeutic point of view, the surgical treatment of cystocele involves several techniques which differ in their approach [4] . We have the upper approach via promontory fixation and the vaginal or lower approach with several variations. These are anterior perineal plasty or anterior colpo-perineorrhaphy by support [5] , i.e. re-tensioning of Halban’s fascia, support, suture of the entire fascia or vagina in a paletot, paletot suspended from the tendon arches, “paravaginal repair” or para-vaginal suspension, bladder support by prosthesis or Campbell’s device [11] [12] [13] [14] . In our study, anterior colpo perineorrhaphy was combined with a posterior plasty in one patient. This variant of vaginal cystocele cure was used because it is more controlled and is customary in our practice. A review of the literature shows that vaginal surgery is often associated with complications, most commonly haemorrhage and iatrogenic rectal and bladder lesions [6] [7] [9] [15] [16] . In our study, there was no morbidity. This absence of perioperative complications demonstrates the surgeon’s good mastery of the surgical technique. The average length of hospital stay was 36 days and the average length of time the bladder catheter was inserted was 2.2 days. Our results corroborate those reported in the literature [4] [9] [10] . These different results show that vaginal cure of cystocele offers a reduction in the length of hospital stay and a short period for wearing the urinary catheter. Evaluation of the results of our surgical treatment after three months showed that four out of five patients had a good functional anatomical result and a good degree of satisfaction. Our results are similar to those of Diabaté in Mali [4] , who reported 53.85% good anatomical results and 46.15% functional results, compared with 46.15% average anatomical results and 53.85% functional results. All patients were reviewed after 6 months. The evaluation showed a good anatomical and functional result and a good degree of satisfaction in all five patients. The strength of our study lies in its rigorous methodology, the first to our knowledge to be carried out in Bouaké in central Côte d’Ivoire. However, it does have its limitations. It is a cross-sectional and descriptive study, and the results therefore merit external validation with a larger, independent sample. It would be useful for future studies with a more significant sample to be carried out in order to assess the substance of our results. However, we believe that these results are clinically relevant because of their strong characterisation in a real-life context.

This study shows that cystocele is pathology of young women. The main cause is dystocial delivery. The diagnosis is most often made late, usually grade II. In view of our results, vaginal cure of cystocele should be the preferred approach. It has a number of advantages (short hospital stay, reduced time to bladder catheterisation, virtually no morbidity or mortality) and above all offers good anatomical and functional results in the medium and long term.

AVION Kouassi Patrice, AKASSIMADOU N’diamoi, AGUIA Brice: statistical analysis and re-reading of the article as well as its drafting.

ZOUAN Freddy, ALLOKA Venance, KAMARA Sadia, DJE Koffi: documentary research and editing of the work.

We have protected the confidentiality of the information gathered during the survey. Thus, an anonymity number was assigned to each survey form with authorisation obtained from the administrative and health authorities.

The authors declare that they have no conflicts of interest.

Avion, K.P., Kramo, N.A.F., Akassimadou, N., Zouan, F., Alloka, V., Kamara, S. and Dje, K. (2023) Vaginal Cystocele Cure at Bouake University Hospital (Chu): Anatomical and Functional Results. Open Journal of Urology, 13, 337-344. https://doi.org/10.4236/oju.2023.139038