Usefulness of ultrasound contrast medium in perineal sonography for visualization of bladder neck funneling - First observations

Objectives. To assess the efficacy of ultrasound contrast medium when imaging bladder neck anatomy with perineal ultrasound, Methods. In 10 female patients with urinary stress or stress-urge incontinence, a new echogenic contrast medium (Echovist) was intravesically administered and perineal ultrasound performed. The examination was done with the women in the upright position both without and with ultrasound contrast medium at rest and during pressing, and the pictures of the bladder base, bladder neck, and urethra were compared. Results. With the patient in the upright position, the ultrasound contrast medium enters the urethra during pressing and bladder neck funneling is identified more accurately than without contrast medium, With Echovist, bladder neck funneling was detected in 9 of the 10 cases but without it in only 4 cases. Conclusions. The use of ultrasound contrast medium results in a better visualization of the bladder neck anatomy. Bladder neck funneling and urinary leakage are seen more distinctly, and this improves the diagnostic reliability in female urinary stress incontinence. This pilot study supports the necessity for further investigations in the use of ultrasound contrast medium as a diagnostic improvement of perineal ultrasound.