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In the case of 81 patients, we conducted a perineal ultrasound and a lateral chain urethrocystography under standard conditions. The data collected were compared. The object of this prospective study was, to estimate the comparability of both methods. We also compared, whether the ultrasonically measured values were different between the supine and upright position. The measured values of both methods corresponded at rest, while during strain the values are different. During Valsalva's manoeuvre, the ultrasound method reflects the mobility of the bladder neck better, while the funnelling of the bladder neck can be examined better by lateral chain urethrocystography. The differences between the supine and upright positions were minor in the ultrasound examination, although the funnelling of the bladder neck could be detected better in the upright position. Our study shows that all important measured values can be collected with perineal ultrasound. Except for the funnelling of the bladder neck, typical findings of incontinence can be better shown with perineal ultrasound.

Perineal sonography and urethrocystography were performed on 45 patients in the same sitting to evaluate the sonographical method with regard to its applicability as a routine examination method. Corresponding results were obtained 14 times (= 30%). In 31 patients (= 70%) urethrocystographic and ultrasonic measurements diverged. The urethrocystogram must therefore remain an integral part in the work-up of urinary incontinence.

In 398 patients suffering from urinary incontinence seven urodynamic parameters were investigated. 75% resp. 78% had a normal max. urethral closure pressure. Only a part of the women was characterized by a descensus of the genital tract. Some more patients showed anatomic abnormalities in the urethrovesical configuration by x-ray urethrocystogram. 1/5 res. 1/3 of descendent anterior vaginal walls proved to have a cystocele. If one requires for successful incontinence operation a normal max. urethral closure pressure and an objectively proven abnormality of the urethrovesical configuration, only 65% resp. 67% of our incontinence women have a chance of being cured by incontinence operation.

In recent years, accurate preoperative diagnosis has been increasingly emphasized as an important therapeutic aspect of urinary incontinence in women. One of the diagnostic modalities employed is the lateral urethrocystogram. 25 patients with recurrent stress induced urinary incontinence were subjected to a dura-sling operation. The median duration of incontinence-related problems until secondary surgery (loop surgery) was 2.6 years. Radiological investigations before and after loop surgery showed, that this operation produces good morphological results, if the preoperative diagnosis is accurate. In 84% of the patients the continence obtained was verified by clinical evidence and radiologic findings.

In Reply.— I believe that a number of urologists would agree with Dr Langlois, and I would gladly rebut his comments. The available data on urgency and frequency and the prevalence of meatal stenosis do not match Dr Langlois's impressions, but rather suggest that he sees a select population of enuretics. Hallgren,1in a study of several hundred enuretic children attending a clinic, found that 22% experienced frequent urination; 7%, urgent urination, and 14%, both. Only 2.5% of the enuretic children had malformed urinary tracts; 3% were found to have obstructive lesions by urethrocystogram; and less than 1% of intravenous pyelograms showed an anomaly. Very different figures have been reported from urologic clinics, for example, by Mahony.2The answer to these questions seems to depend on the pool of patients and on one's special interest, but Hallgren's data are probably closest to the experience of family practitioners and