Objective To investigate the application value of transperineal four-dimensional ultrasound in female patients with stress urinary incontinence. Methods Transperineal four-dimensional ultrasound was performed in 32 cases of normal women and 39 cases of female patients with stress urinary in continence. In condition of resting and tension, the length of urethra and the thickness of the bladder detrusor were observed in the resting condition; the pelvic diaphragm hiatal area，the vertical distance from vesical neck to the edge of the pubic symphysis, posterior angle of bladder urethral, urethral rotation angle were measured in the resting and tension condition; The bladder neck movement was calculated. Results The vertical distance from vesical neck to the edge of the pubic symphysis showed no statistical difference between SUI group and control group (P=0.426) in resting condition; the vertical distance from vesical neck to the edge of the pubic symphysis, posterior angle of bladder urethra and the pelvic diaphragm hiatal area of SUI group were significantly greater than the control group (P<0.05). The bladder neck movement and urethral rotation angle were significantly higher than the control group (P<0.05). Conclusions The transperineal four-dimensional ultrasound can dynamically evaluated female stress urinary incontinence in patients with pelvic floor anatomy and function, and is worthy of clinical application.