VOIDING CYSTOURETHROGRAPHY IN FEMALE STRESS-INCONTINENCE

OBJECTIVES. The aims of this study were to determine the sensitivity o f voiding cystourethrography (VCUG) in detecting incontinence in women with a history of leakage, the positive and negative predictive value s of VCUG for stress incontinence, and how often a history of leakage is accompanied by urethrocele on VCUG and to correlate urethral anatom ic measurements with the presence of urethrocele and stress incontinen ce on VCUG. SUBJECTS AND METHODS. A total of 159 women with incontinen ce or voiding dysfunction were evaluated by VCUG and urodynamic study (UDS). RESULTS. VCUG detected stress incontinence in 76% of women with a specific history of stress incontinence. Of 61 women with genuine s tress incontinence proven on UDS, only 37 (61%) were identified on VCU G, yielding a positive predictive value of 56%. Twenty-one of 29 women without genuine stress incontinence on UDS but with apparent stress i ncontinence on VCUG had detrusor instability on UDS, so that urge inco ntinence was falsely diagnosed as stress incontinence. VCUG had a nega tive predictive value of 74%. In 40 women with urethroceles, 26 had st ress incontinence on VCUG. The anatomic changes in posterior urethrove sical angle, urethral descent, and urethral inclination denote urethro celes but do not correlate with the presence of stress incontinence. C ONCLUSION. In the evaluation of stress incontinence, VCUG is limited b ecause of detrusor instability producing urge incontinence and therefo re resulting in false-positive stress incontinence. The anatomic measu rements of posterior urethrovesical angle change, urethral descent, an d urethral inclination as well as the presence of urethrocele have lim ited ability in predicting stress incontinence.