*4.1.1 Descensus of the anterior compartment*

A descensus in the anterior compartment causes a cystocele. The anterior vaginal wall is connected to the bladder by a layer of connective tissue (fascia endopelvina). Central overstretching results in a pulsation cystocele with passing of the rugae vaginalis and preserved longitudinal sulci (**Figure 1**). This is more often observed in older patients. In case of lateral tear off of the vagina (uni- or bilateral) from the arcus tendineus fasciae pelvis, a traction cystocele with preserved rugae is found [9]. This defect often occurs after birth trauma and is also found in younger women. Combination of both are common. This disorder can cause urinary incontinence and/ or bladder voiding dysfunction. Level-III-Defects are one of the most common reasons for stress incontinence, because of the missing lateral fixation of the urethra [8].
