Purpose: The aim of this study was to explore differences in the bladder neck configuration and segmental urethral mobility during the cough stress test (CST) in the supine and standing positions between women with and without stress urinary incontinence (SUI). Methods: This prospective study included 100 control women and 100 incontinent women who had a CST with transperineal ultrasonography. The bladder neck configuration and urethral mobility were described in terms of urethral funneling, bladder neck descent (BND), retrovesical angle (RVA), urethral rotation angle, and urethral mobility at six points along the urethra (vectors 1 to 6). The two groups’ ultrasound findings in the two positions were compared. Results: Valid data were collected from 78 control women and 90 women with SUI. Significant differences were found in age and body mass index between the two groups (P<0.01). Urethral funneling was found in 33 women (36.7%) with SUI and five continent women (6.4%) and altered little in the standing position. In the standing position, the mean RVA significantly increased (160° to 179°, P<0.001) in the SUI group; The mean vector of points 1 to 6 significantly increased in the control group (all P<0.001). The RVA, BND, and vectors 1 to 4 were significantly greater (all P≤0.01) in women with SUI than without, in both positions. Conclusion Urethral funneling was an intrinsic anatomical characteristic relative to SUI. Weak upper- and mid-urethral support and an unstable connection between the trigone and proximal urethra were the anatomical signs of SUI.

Objective:To study the association between urethral configuration and mobility and female stress urinary incontinence (SUI).Methods:This was a prospective study in 176 women with pure SUI and 132 healthy women who undertook transperineal ultrasound in Second Xiangya Hospital between July 2017 and April 2020. Urethral funneling, bladder neck descent (BND) and rotation, retrovesical angle (RVA), and urethral mobility of 6 points along the urethra (Vectors 1 to 6) were measured by transperineal ultrasound during the cough stress test (CST). The differences between the two groups were tested using independent t-test. The relationship between ultrasound findings and SUI was analyzed by ROC curve and Logistic regression analysis. Results:Urethral funneling was found in 27.8% of women with SUI and 3.0% of controlled women.BND [(25.2±7.4)mm vs (21.5±8.6)mm], RVA [(171.5±26.3)° vs (159.4±26.6)°] and Vectors 1-6 [(2.97±0.89), (2.93±0.75), (2.67±0.67), (2.34±0.66), (2.27±0.67) , (2.36±0.69) vs (2.59±1.03), (2.54±0.83), (2.27±0.64), (1.99±0.50), (1.94±0.49), (2.05±0.53)] were significantly increased in SUI group (all P≤0.001). Logistic regression analysis yielded odds ratios of 10.06(95% CI=4.18-24.20), 2.71(95% CI=1.81-4.05) and 3.21(95% CI=2.01-5.14) for urethral funneling, Vector 3 and Vector 4 to predict for SUI, respectively. Conclusions:Transperineal ultrasound can be used to evaluate the real-time change of the bladder neck and urethral configuration and mobility in CST. Urethral funneling and mid-urethral hypermobility can be used to predict SUI.