Our objective was to assess the diagnostic value of transperineal ultrasonographic posterior urethrovesical angle measurement in stress incontinent women and evaluate the effects of different surgical techniques on the posterior urethrovesical angle. Posterior urethrovesical angle was measured by transperineal ultrasonography in 35 stress incontinent (study group) and 42 stress continent (control group) women. In the study group, 14 women mere treated by Burch colposuspension, 10 by the Marshll-Marchetti-Krantz procedure, and 11 by anterior colporrhaphy with Kelly plication. The mean measurement was not different at rest in both the stress incontinent and the continent women (p < 0.05). A significant increase in the posterior urethrovesical angle was found during the Valsalva maneuver in both groups, although this difference was more prominent in the incontinent women (8.9 degrees +/- 16.8 degrees vs 37.5 degrees +/- 17.0 degrees, p < 0.001). A significant difference was seen at the posterior urethrovesical angle both at rest and during stress after Burch colposuspension (rest, p < 0.05; stress, p < 0.001) and the Marshll-Marchetti-Krantz procedure (rest, p < 0.001; stress, p < 0.001). No difference at rest but marked difference during stress (p < 0.01) were seen after anterior colporrhaphy with Kelly plication. However, stabilization of the posterior urethrovesical angle with this technique was poor in comparison with the Burch and Marshall-Marchetti-Krantz operations (p < 0.05). Transvaginal ultrasonographic measurement of the posterior urethrovesical angle is a valuable test in the diagnosis of genuine stress incontinence. Burch colposuspension and Marshall-Marchetti-Krantz operations are more effective procedures in reconstitution and stabilization of the angle than is anterior colporrhaphy with Kelly plication.