An ultrasonic evaluation of the bladder base and urethrovesical junction, at rest and during stress, using a tansrectal 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 21 cm (mean 1.3 cm 2 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 <1 cm (mean 0.48 cm 2 0.23 cm and 0.54 cm & 0.29 cm, respectively, p < 0.05). The sensitivity of ultrasonic evaluation of women with stress urinary incontinence (when l-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. Indexing Words: Urethrovesical junction in women Stress urinary incontinence Urinary incontinence, stress Poor anatomic support of the bladder base and urethrovesical junction is the basic pathophysiology of genuine stress urinary incontinence.' The poorly supported urethra is no longer in the intra-abdominal pressure sphere, resulting in inadequate abdominal pressure transmission to the urethra during stress as well as involuntary loss of ~r i n e . ~-~ Anatomic evaluation of the support to the bladder base a t rest and during stress is an important part of the preoperative evaluation of women with stress urinary incontin e n ~e . ~, ~ Real-time ultrasonography using an abdominal probe was recently tried for anatomical evaluation of the bladder base and urethrovesical j ~n c t i o n . ~" Unfortunately, the bladder base is often hidden behind the pubic bone in women with From the LAC-