Vaginal ultrasonography versus colpo-cysto-urethrography in the evaluation of female urinary incontinence.

To compare the information of bladder neck suspension given by colpo-cysto-urethrography (CCU) and vaginal ultra-sonography (US), 44 women with various grades of incontinence were examined by both methods. The criteria for evaluation of incontinence for each method were applied on both procedures. CCU-diagnoses of type of bladder neck descent were compared as well as US-measurements of bladder neck position and mobility in relation to the symphysis pubis during rest, Valsalva and withholding. The interobserver agreement of diagnosis was 58%, which is comparable to interobserver agreement for CCU. The measurements of bladder neck suspension by bladder to symphysis (BS)-distance and rotation-angle in relation to the symphysis pubis, revealed almost identical results for the two procedures. The US-measurements had a better accuracy than the CCU measurements. Furthermore, hypermobility of the bladder neck was related to grade of incontinence and to diagnoses including anterior suspension defects. Presence of a cysto- or rectocele affected the size of the rotation angles. Patients with a cystocele had a 16 degrees larger rotation angle by both procedures. Presence of a rectocele increased the rotation angle, measured by US, but decreased the angles, measured by CCU. Furthermore, the ability to withhold was decreased, when the patient had a rectocele. Since the same information of bladder neck suspension is provided by the two methods, and since the US-criteria revealed a better accuracy and a good clinical reliability, ultrasonography is recommended for evaluation of bladder neck anatomy--also for practical and economical reasons.