Rectocele combined with cystourethrocele represents a frequent and clinically complex manifestation of pelvic floor dysfunction. Traditionally, these entities have been interpreted as isolated compartmental defects requiring local anatomical correction. However, accumulating anatomical, functional, and radiological evidence suggests that combined rectocele and cystourethrocele reflect a multilevel failure of the pelvic floor support system rather than a single-site structural abnormality.

This narrative review analyzes contemporary literature addressing anatomical interactions between anterior and posterior compartments, the biomechanical role of the rectovaginal septum and pubocervical fascia, levator ani dysfunction, and functional alterations detected by defecography, high-resolution anorectal manometry, and dynamic magnetic resonance imaging. The reviewed data demonstrate that symptom severity frequently does not correlate with the morphological extent of rectocele. Functional disturbances, including impaired anal relaxation, altered pressure gradients, and disrupted load redistribution within the pelvic floor, appear to play a decisive role in clinical presentation.

The concept of multilevel pelvic floor failure provides a more coherent framework for understanding the coexistence of rectocele and cystourethrocele. Damage to muscular and fascial structures, age-related connective tissue changes, chronic increases in intra-abdominal pressure, and obstetric trauma interact in a cumulative manner, leading to progressive destabilization of pelvic support. This systemic perspective explains the limited durability of isolated defect correction and underscores the importance of functional assessment in clinical decision-making.

Recognition of rectocele combined with cystourethrocele as a manifestation of integrated pelvic floor failure may refine pathogenetic interpretation and serve as a conceptual basis for further development of reconstructive strategies aimed at restoring biomechanical balance rather than correcting isolated anatomical deformities.

Rectocele, cystourethrocele, pelvic floor dysfunction, multilevel pelvic failure

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