Eighty-five patients underwent transabdominal (TAU) and transvaginal ultrasound (TVU) 24 hours before elective surgery for gynecologic disease. No obstetric cases were included. The diagnostic outcome of TVU was not significantly better than that of TAU in spite of a better image quality. The evaluation of large ovarian cysts and sizeable fibroids was difficult with TVU due to the limited field of view. Endometrial pathology was clearly diagnosed by TVU. We recommend using TVU in combination with TAU, especially in cases of unclear pelvic pathology or when larger masses are present.