A new method for sonographic urethrocystography and simultaneous pressure-flow measurements.

By the use of a vaginal scanner and simultaneous pressure-flow measurements, we developed a new method to study bladder and urethral function. During urodynamic pressure measurements, a vaginal scanner was positioned adjacent to the vulva just underneath the external urethral orifice to scan the bladder, the vesicourethral junction, and the urethra. This technique was termed "introital sonography." Twenty patients with the symptom of "loss of urine" and ten healthy volunteers without urinary symptoms were studied. Introital sonography displayed the bladder, the urethra, and the symphysis in all women. No incontinence was demonstrable in the healthy control group. Opening of the bladder neck was always visible during micturition, and a normal flow pattern could be observed in all healthy women. In five patients with detrusor instability, opening of the bladder neck was found during cystometry, displaying isolated detrusor contractions. Fifteen patients with genuine stress incontinence demonstrated marked descent of the vesicourethral junction under stressful situations. For the diagnosis of detrusor instability, sonographic visualization of bladder neck opening confirms the entity of isolated detrusor contractions during cystometry and thus helps to exclude tonometric artifacts. Introital sonography not only confirms the diagnosis of genuine stress incontinence by accurately demonstrating the abnormal vesicourethral anatomy, but also provides information that is essential for selecting the proper operative procedure. The lack of radiation exposure and contrast medium makes this inexpensive technique most useful for long-term video pressure-flow studies in patients with bladder dysfunction.