International Urogynecology Journal

, Volume 9, Issue 6, pp 365–369 | Cite as

Anatomical assessment of the bladder outlet and proximal urethra using ultrasound and videocystourethrography

  • H. P. Dietz
  • P. D. Wilson
Original Article


In a prospective blinded comparative clinical study 125 women underwent videocystourethrography and cystometry as well as transperineal ultrasound as part of their diagnostic work-up for urinary incontinence or after incontinence-correcting surgery. Comparisons between ultrasound and X-ray imaging were carried out on 117 women for whom complete data sets were available. Mean bladder neck descent was significantly greater with ultrasound compared to VCU (US: 2.1±1.2 cm vs. VCU: 1.8±0.9;P=0.003). Rotation of the proximal urethra was not always seen on X-ray, but when it was (44 patients) there was good correlation with US (US rotation 55±27° vs. VCU rotation 55°±29). There was also good agreement between both tests regarding visualization of funneling or opening of the proximal urethra, with both tests showing equivalent results in 95 out of 117 patients (Cohen's κ 0.58). On comparing extensive funneling to the midurethra on US with frank leakage on VCU the methods were in agreement for 90 out of 117 patients (κ 0.54). Overall a good correlation between ultrasound and radiological findings was observed. Both methods allow anatomic assessment of the bladder neck and have different strengths and weaknesses. Ultrasound imaging may be preferable as it is chaper, requires less technological back-up and avoids the risks of radiation exposure and allergic reactions to contrast medium.


Cystourethrography Female urinary incontinence Perineal ultrasound Ultrasound Urodynamics 


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  1. 1.
    Johnson JD, Lamensdorf H, Hollander IN et al. Use of transvaginal endosonography in the evaluation of women with stress urinary incontinence.J Urol 1992;147:421–425Google Scholar
  2. 2.
    Quinn MJ, Beynon J, Mortensen NJ McC et al. Transvaginal endosonography: a new method to study the anatomy of the lower urinary tract in urinary stress incontinence.Br J Urol 1988;62:414–418Google Scholar
  3. 3.
    Quinn MJ, Beynon J, Mortensen NJ McC et al. Vaginal endosonography in the postoperative assessment of colposuspension.Br J Urol 1989;63:295–300Google Scholar
  4. 4.
    Mouritsen L, Strandberg C. Vaginal ultrasonography versus colpocystourethrography in the evaluation of female urinary incontinence.Acta Obstet Gynecol Scand 1994;68:338–342Google Scholar
  5. 5.
    Bergman A, Ballard CA, Platt LD. Ultrasonic evaluation of urethrovesical junction in women with stress incontinence.J Clin Ultrasound 1988;16:295–300Google Scholar
  6. 6.
    Bergman A, McKenzie CJ, Richmond J, Ballard CA, Platt LD. Transrectal ultrasound versus cystography in the evaluation of anatomical stress urinary incontinence.Br J Urol 1988;62:228–234Google Scholar
  7. 7.
    Braccini G, Pannocchia P, Alderigi L, Gigoni R, Calderazzi A. Comparison of colpocystourethrorectography and transrectal ultrasonography in the assessment of female urinary incontinence.Radiol Med Torino 1991;82:101–106Google Scholar
  8. 8.
    Dietz HP. Perineal Scan: eine neue Untersuchungsmethode in der Gynaekologie und Geburtshilfe. Thesis, University of Heidelberg Medical School, Heidelberg, Germany, 1989:85–113Google Scholar
  9. 9.
    Grischke EM, Dietz HP, Jeanty P, Schmidt W. Eine neue Untersuchungsmethode: Perineal Scan in der Gynaekologie und der Geburtshilfe.Ultraschall 1986;7:154–161Google Scholar
  10. 10.
    Grischke EM. Perinealsonographie.Gynaekol Praxis 1989; 13:473–480Google Scholar
  11. 11.
    Grischke EM, Anton HW, Dietz HP, Schmidt W. Perinealsonographie und roentgenologische Verfahren im Rahmen der weiblichen Harninkontinenzdiagnostik.Geburtsch Frauenheilk 1989;49:733–736Google Scholar
  12. 12.
    Kohorn EI, Scioscia AL, Jeanty P, Hobins JC. Ultrasound cystourethrography by perineal scanning for the assessment of female stress urinary incontinence.Obstet Gynecol 1986;68:269–272Google Scholar
  13. 13.
    Enzelsberger H, Skodler WD, Wolf G, Reinhold E. Comparative study of introital sonography and the urethrocystogram in women before and after surgery for stress incontinence.Ultraschall Med 1991; 12: 149–152Google Scholar
  14. 14.
    Schaer G, Koechli OR, Schuessler B, Haller U. Simultaneous perineal ultrasound and urodynamic assessment of female urinary incontinence: initial observations.Int Urogynecol J 1995;6:168–174Google Scholar
  15. 15.
    Schaer GN, Koelbl H, Voigt R et al. Recommendations of the German Association of Urogynecology on functional sonography of the lower female urinary tract.Int Urogynecol J 1996;7:105–108Google Scholar
  16. 16.
    Bates CP, Corney C. Synchronous cine/pressure/flow cystography: a method of routine urodynamic investigation.Br J Radiol 1971;44:44–50Google Scholar
  17. 17.
    Schaer GN, Koechli OR, Schuessler B, Haller U. Perineal ultrasound for evaluating the bladder neck in urinary stress incontinence.Obstet Gynecol 1995;85:220–224Google Scholar
  18. 18.
    Schaer G, Kochli OR, Hutzli C, Fink D, Haller U. Value of the lateral urethrocystogram and perineal ultrasound: are there differences? A prospective study.Geburtsch Frauenheilk 1994;54:75–79Google Scholar
  19. 19.
    Schaer GN, Koechli OR, Schuessler B, Haller U. Usefulness of ultrasound contrast medium in perineal sonography for visualization of bladder neck funneling-first observations.Urology 1996;47:452–453Google Scholar
  20. 20.
    Dietz HP, Ellin KE, Rades T, Wilson PD. The development of an ultrasound contrast medium for incontinence diagnostics.Neurourol Urodyn 1997;16:390–392Google Scholar
  21. 21.
    Quinn MJ. Vaginal ultrasound and urinary stress incontinence. In: Drife JO, Hilton P, Stanton SL (eds). London: Springer, 1990;129–141Google Scholar
  22. 22.
    Sacco E, Rigon G, Carbone A et al. Ultrasonographic and urodynamic evaluation in stress incontinence.Minerva Ginecol 1993;45:519–525Google Scholar
  23. 23.
    Gordon D, Pearce M, Norton P, Stanton SL. Comparison of ultrasound and lateral chain urethrocystography in the determination of bladder neck descent.Am J Obstet Gynecol 1989;160:182–185Google Scholar
  24. 24.
    Koelbl H, Bernaschek G, Wolf G. A comparative study of perineal ultrasound scanning and urethrocystography in patients with genuine stress incontinence.Arch Gynecol Obstet 1988;244:39–45Google Scholar
  25. 25.
    Voigt R, Halaska M, Michels W et al. Examination of the urethrovesical junction using perineal sonography compared to urethrocystography using a bead chain.Int Urogynecol J 1994;5:212–214Google Scholar

Copyright information

© Springer-Verlag London Ltd 1998

Authors and Affiliations

  • H. P. Dietz
    • 1
  • P. D. Wilson
    • 1
  1. 1.Dunedin School of MedicineUniversity of OtagoDunedinNew Zealand

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