Imaging the female urethra with ultrasound

Four ultrasonic approaches—the transabdominal, transrectal, endo-vaginal, and translabial—have been used in the investigation of stress incontinence. We have compared the four techniques in a large group of patients. In our experience the combination of the translabial and transrectal approaches has proved most helpful, with the transvaginal technique as a useful backup if the transrectal approach is impractical. Ultrasonic features of stress incontinence that have been described include bladder base descent, angulation changes in the urethra or bladder base, and funneling. A comparison of the various ultrasonic features of stress incontinence has been made, and funneling has been found to correlate much better with incontinence than urethral angle changes or urethral movement. Two forms of stress incontinence are seen: there may be localized loss of the posterior internal urethral support or an overall weakness of the pelvic musculature. The use of ultrasound in the distinction between these two conditions may be helpful in planning surgery.