Клинические фенотипы симптомного цистоцеле: анализ анатомических и функциональный нарушений

Clinical phenotypes of symptomatic cystocele: analysis of anatomical and functional disorders

Objective. To identify clinical phenotypes of symptomatic cystocele and analyze anatomical and functional disorders in a patient cohort. Design. An open-label, prospective, cross-sectional analytical study with elements of mathematical modeling. Patients and methods. A detailed analysis of clinical determinants was performed in 70 women with stage II-III symptomatic cystocele according to the POP-Q classification. The mean age of patients was 46.3 ± 8.2 years, and the mean parity was 2.8 ± 1.1. Hierarchical cluster analysis and K-means clustering (k = 3) were used based on standardized scores of symptom questionnaires (UDI-6, POPDI-6, CRADI-8) and quality of life domains (P-QOL). The dissociation between “anatomy and cystocele symptoms” was assessed by comparing the POP-Q stage with the total PFDI-20 score. Multiple linear regression was used to identify independent predictors of symptom severity. Results. Three clinical phenotypes were identified: “predominantly urinary” (n = 24, 34.3%) with dominant urological symptoms (UDI-6: 78.4 ± 15.2), “complex pelvic” (n = 28, 40.0%) with symptomatic involvement of all compartments (PFDI-20: 179.6 ± 44.2), and “compensated” (n = 18, 25.7%) with minimal clinical symptoms (PFDI-20: 77.5 ± 28.3). A clear dissociation between anatomy and clinical presentation was determined: 11.4% of women had stage III cystocele with PFDI-20 < 100 points, while 17.1% of patients with stage II cystocele had PFDI-20 > 200 points. According to multiple regression (R2= 0.683), urinary urgency was the most significant predictor of symptom severity (β = 0.486, p < 0.001), surpassing anatomical stage (β = 0.214, p = 0.001). A synergistic interaction between cystocele stage and body mass index (BMI) was established ( β = 0.134, p = 0.017). Conclusion. Symptomatic cystocele is a heterogeneous disease with three distinct clinical phenotypes. A clear dissociation between anatomical changes and clinical symptoms in 28.5% of patients indicates the necessity to reconsider traditional approaches to diagnosis and treatment. Functional disorders (urinary urgency) and metabolic factors (BMI) are more significant determinants of disease severity than the anatomical stage of cystocele. © 2025, Dynasty Publishing House. All rights reserved.