PREOPERATIVE AND POSTOPERATIVE TRANSPERINEAL ULTRASONOGRAPHIC ASSESSMENT OF THE POSTERIOR URETHROVESICAL ANGLE IN STRESS INCONTINENT WOMEN

Our objective was to assess the diagnostic value of transperineal ultr asonographic posterior urethrovesical angle measurement in stress inco ntinent women and evaluate the effects of different surgical technique s on the posterior urethrovesical angle. Posterior urethrovesical angl e was measured by transperineal ultrasonography in 35 stress incontine nt (study group) and 42 stress continent (control group) women. In the study group, 14 women mere treated by Burch colposuspension, 10 by th e Marshll-Marchetti-Krantz procedure, and 11 by anterior colporrhaphy with Kelly plication. The mean measurement was not different at rest i n both the stress incontinent and the continent women (p < 0.05). A si gnificant increase in the posterior urethrovesical angle was found dur ing the Valsalva maneuver in both groups, although this difference was more prominent in the incontinent women (8.9 degrees +/- 16.8 degrees vs 37.5 degrees +/- 17.0 degrees, p < 0.001). A significant differenc e was seen at the posterior urethrovesical angle both at rest and duri ng stress after Burch colposuspension (rest, p < 0.05; stress, p < 0.0 01) and the Marshll-Marchetti-Krantz procedure (rest, p < 0.001; stres s, p < 0.001). No difference at rest but marked difference during stre ss (p < 0.01) were seen after anterior colporrhaphy with Kelly plicati on. However, stabilization of the posterior urethrovesical angle with this technique was poor in comparison with the Burch and Marshall-Marc hetti-Krantz operations (p < 0.05). Transvaginal ultrasonographic meas urement of the posterior urethrovesical angle is a valuable test in th e diagnosis of genuine stress incontinence. Burch colposuspension and Marshall-Marchetti-Krantz operations are more effective procedures in reconstitution and stabilization of the angle than is anterior colporr haphy with Kelly plication.