Ultrasonic evaluation of urethrovesical junction in women with stress urinary incontinence

An ultrasonic evaluation of the bladder base and urethrovesical junction, at rest and during stress, using a transrectal probe, was performed on 24 continent and 67 incontinent patients. Forty-four of the incontinent patients had clinical and urodynamic diagnoses of stress urinary incontinence and 23 patients had detrusor instability incontinence. Thirty-eight of the 44 patients (86%) with urodynamically and urethroscopically proven genuine stress urinary incontinence and a weak urethral sphincter had a urethrovesical junction (UVJ) drop during stress of greater than or equal to 1 cm (mean 1.3 cm +/- 0.6 cm), as demonstrated on transrectal ultrasonic evaluation. All 23 patients with detrusor instability and 22 of the 24 continent (control) patients had UVJ drop on straining of less than 1 cm (mean 0.48 cm +/- 0.23 cm and 0.54 cm +/- 0.29 cm, respectively, p less than 0.05). The sensitivity of ultrasonic evaluation of women with stress urinary incontinence (when 1-cm drop of UVJ is considered as the upper boundary of normal) was 86% and the specificity was 91%. This ultrasound technique is quick, simple, and appears to be accurate. We believe this technique should be considered in the preoperative evaluation of women with stress urinary incontinence.