IMPROVEMENT OF PERINEAL SONOGRAPHIC BLADDER NECK IMAGING WITH ULTRASOUND CONTRAST-MEDIUM

Objective: To assess the efficacy of ultrasound contrast medium when i maging bladder neck anatomy in perineal ultrasound. Methods: In 39 wom en with clinically and urodynamically proven urinary stress or stress- urge incontinence, a new echogenic contrast medium (Echovist) was admi nistered transurethrally and perineal ultrasound was performed. Women were examined in the upright position both without and with ultrasound contrast medium at rest and during Valsalva maneuver, and the picture s of the bladder base, bladder neck, and urethra were compared. Result s: With the subject in the upright position, the contrast medium lay a t the lowest point of the bladder and resulted in a reverse picture of the bladder base and bladder neck and clear visualization of these st ructures. In women with urinary stress incontinence, the ultrasound co ntrast medium entered the urethra during Valsalva, and bladder neck fu nneling was identified more accurately than without contrast medium. W ith Echovist, bladder neck funneling was detected in 38 of the 39 case s, compared with only 19 when it was not used. Furthermore, when the b ladder neck, urethra, or bladder base were not visible with plain peri neal ultrasound, they were seen when ultrasound contrast medium was us ed. The contrast agent was well tolerated, and there were no adverse s ide effects. Conclusion: The use of ultrasound contrast medium improve s visualization of the bladder neck anatomy. Bladder neck funneling an d urinary leakage are seen more distinctly, and this improves the diag nostic reliability in female urinary stress incontinence.