Purpose. In the present study we want to propose a classification system to quantify cystoceles by perineal ultrasound (PUS).Materials and Methods.120 PUS data were analyzed measuring the distance between the lowest point of the bladder and the midpubic line (MPL) during rest and Valsalva. Results were classified into groups and compared to POP-Q using theκ-coefficient. Results for exact bladder position were checked for interrater reliability using ICC and Pearson’s coefficient and results for classification were checked using theκ-coefficient. Bladder positions at rest and Valsalva were correlated with the distance between these points.Results. Highly significant differences concerning the position at rest and the distance between rest and Valsalva were found between the groups. For the interrater agreement, the Pearson correlation coefficient wasρ=0.98, the ICC (A-1) = 0.98, andκ=1.00. Comparing the classification results for POP-Q and PUS, the kappa-coefficient wasκ=0.65.Conclusion. PUS using the MPL and the classification system is a highly reliable tool for the evaluation of cystoceles. PUS shows good correlation with POP-Q. Furthermore, PUS offers a doubtless identification of the descending organ. Further studies are needed to evaluate the clinical use of the classification system proposed here.