[Significance of transrectal ultrasonography in surgery for stress urinary incontinence and cystocele. Assessment of the bladder neck suspension by measuring posterior urethrovesical angle and angle of inclination of the upper urethra].

We treated 42 females (26 with genuine stress urinary incontinence, 13 with incontinence and cystocele, and 3 with cystocele) with bladder neck suspension using transrectal ultrasonography during operation. The optimum tightness of suspension was decided by adjusting the posterior urethrovesical angle to about 90 degrees in 26 patients with genuine stress urinary incontinence accompanied with flattened posterior urethrovesical angles and by adjusting the angle of inclination of the upper urethra to about 10 degrees in 16 patients with cystocele accompanied with rotationally descended urethra. Urinary continence was achieved in 35 of 39 patients presenting with urinary incontinence. Three patients with cystocele without urinary incontinence remained dry after the operation. The average of maximum urinary flow rate significantly increased after operation. The angles of inclination of the upper urethra measured on the ultrasonogram during operation corresponded well with those measured on the post-operative lateral urethrocystogram. In 26 patients without cystocele, the angles of inclination of the upper urethra and the posterior urethrovesical angles were correlated significantly on the pre-operative urethrocystograms. Roentgenographic changes in pre- and post-operative urethrocystograms showed concomitant restoration in the angles of inclination of the upper urethra and in the posterior urethrovesical angles as well as significant elevation of the bladder neck. Present results indicate that the angles of inclination of the upper urethra measured by transrectal ultrasonography during operation as well as the posterior urethrovesical angles are useful and reliable to decide the optimum tightness of bladder neck suspension for the patients with stress urinary incontinence accompanied with rotationally descended urethra.(ABSTRACT TRUNCATED AT 250 WORDS)