If symptoms are moderately bothersome, the doctor may recommend a pessary, a device placed in the vagina to hold the bladder in place and to block protrusion. Treatment can consist of a combination of non-surgical and surgical management. Treatment choice is also related to age, desire to have children, severity of impairment, desire to continue sexual intercourse and other diseases that a woman may have. Non-surgical
Cystocele is often treated by non-surgical means:

Pessary – This is a removable device inserted into the vagina to support the anterior vaginal wall. Pessaries come in many different shapes and sizes. There are sometimes complications with the use of a pessary. Pelvic floor muscle therapy – Pelvic floor exercises to strengthen vaginal support can be of benefit. Specialized physical therapy can be prescribed to help strengthen the pelvic floor muscles. Dietary changes – Ingesting high fiber foods will aid in promoting bowel movements. Estrogen – intravaginal administration helps to prevent pelvic muscle atrophy

Surgery
The surgery to repair the anterior vaginal wall may be combined with other procedures that will repair the other points of pelvic organ support such as anterior-posterior repair and anterior colporrhaphy. Treatment of cystocele often accompanies the more invasive hysterectomy. Since the failure rate in cystocele repair remains high, additional surgery may be needed.
Renpennings syndrome is a neurodevelopmental disorder recognised in males that causes intellectual disability, mild growth retardation with examples in the testes and head, and a somewhat short stature. The condition only affects males, starting at birth. Presentation
People with Renpennings typically begin learning language at an ordinary pace, but by the age of 3–4 they experience a regression in mental and physical development, such as mild low muscle tone resulting in elongated faces and rapid loss in the normal growth of the head (microcephaly). Small testes and short stature are also known to commonly occur. Genetics
It is associated with mutations in the PQBP1 gene. The gene product is a polyglutamine-binding protein involved in transcription and pre-mRNA splicing. The gene itself is located on the short arm of the X chromosome (Xp11.23). The most common mutations causing this condition occur in exon 4. Diagnosis
This diagnosis may be suspected on clinical grounds but should be confirmed by sequencing the PQBP1 gene. Treatment
There is no specific or curative treatment for this condition at present. Management is supportive

Epidemiology
This condition normally only occurs in males but a case in a female has been reported. History
This condition was first characterized in 1962. and later described by Hans Renpenning in 1963 after he documented these traits on many children in one family alone. See also
Lujan-Fryns syndrome
Fragile x syndrome

References


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