Application of transrectal sonography in the diagnosis and treatment of female stress urinary incontinence.

One hundred and two women with genuine stress urinary incontinence (SUI) were examined by transrectal sonography and urodynamics. The patients were classified into five types according to their intrinsic and extrinsic continence mechanism defects. Twenty-five patients had a hypermobile bladder neck and urethra (type 1); 31 patients had an incompetent bladder neck and a hypermobile urethra (type 2); 31 patients showed an incompetent urethral sphincter in addition to urethral hypermobility (type 3); 12 patients had a cystocele accompanying incompetent urethral sphincter and hypermobile urethra (type 4); the remaining 3 showed an incompetent urethral sphincter without hypermobility of the urethra (type 5). Whereas the distance from the lower margin of symphysis pubis to the bladder neck (pubovesical ligament; PVL) showed a significant increase in straining state of types 3 and 4, this was not the case in types 1, 2 and 5. There is a significant increase in the posteroinferior rotational of PVL angle on straining compared with resting in types 1, 2, 3, and 4, but not in type 5. The angle on straining also showed an increased tendency from type 1 to 4. The functional degree of SUI showed a significant increase from type 1 to 5. With this classification, the functional class of SUI is thus well correlated with the anatomical defects. The PVL length and the angle of external rotation of this axis are significantly implicated in the severity of SUI.