Sonographic evaluation of the bladder neck in continent and stress-incontinent women

Objective: To evaluate a new sonographic method to measure depth and width of proximal urethral dilation during coughing and Valsalva maneuver and to report its use in a group of stress-incontinent and continent women. Methods: Fifty-eight women were evaluated, 30 with and 28 without stress in continence proven urodynamically, with a bladder volume of 300 mL and the s ubjects upright. Urethral pressure profiles at rest were performed with a 1 0 French microtip pressure catheter. Bladder neck dilation and descent were assessed by perineal ultrasound (5 MHz curved linear array transducer) wit h the help of ultrasound contrast medium (galactose suspension-Echovist-300 ), whereas abdominal pressure was assessed with an intrarectal balloon cath eter. Statistical analysis used the nonparametric Mann-Whitney test. Results: The depth and diameter of urethral dilation could be measured in a ll women. During Valsalva, all 30 incontinent women exhibited urethral dila tion. One incontinent woman showed dilation only while performing a Valsalv a maneuver, not during coughing. In the continent group, 12 women presented dilation during Valsalva and six during coughing. In continent women, dila tion was visible only in those who were parous. Nulliparous women did not h ave dilation during Valsalva or coughing. Bladder neck descent was visible in continent and incontinent women. Conclusion: This method permits quantification of depth and diameter of bla dder neck dilation, showing that both incontinent and continent women might have bladder neck dilation and that urinary continence can be established at different locations along the urethra in different women. parity seems t o be a main prerequisite for a proximal urethral defect with bladder neck d ilation. (C) 1999 by The American College of Obstetricians and Gynecologist s.