Does pelvic organ prolapse quantification exam predict urethral mobility in stages 0 and I prolapse?

Noblett, Karen; Lane, Felicia; Driskill, Christopher S.

doi:10.1007/s00192-005-1315-4

Cited by 23 publications

(20 citation statements)

References 5 publications

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“…The first study by Montella [4] found that "visual assessment of anterior vaginal wall descent does not provide diagnostic accuracy and acceptable sensitivity and specificity to determine urethrovesical junction mobility." Cogan et al [3] found a high correlation between Aa and urethral hypermobility at stages II to IV prolapse only, while Noblett et al [2] found the POP-Q system highly predictive of straining urethral angle in all stages of prolapse. We investigated whether a more distal location of the cotton swab in a funneled urethrovesical junction secondary to prolapse may be responsible for a poor correlation between point Aa and the straining Q-tip values.…”

Section: Discussionmentioning

confidence: 99%

“…The ability to assess urethral mobility accurately without urethral instrumentation has also been evaluated [2][3][4][5]. The pelvic organ prolapse quantification (POP-Q) staging system was formally adopted at the International Continence Society in October 1995.…”

Section: Introductionmentioning

confidence: 99%

“…However, published data have been contradictory. One prospective study [2] found the POP-Q system to be highly predictive of straining urethral angle in all stages of prolapse; however, three other studies failed to confirm a strong correlation between those two variables [3][4][5].…”

Section: Introductionmentioning

confidence: 99%

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Effect of anatomic urethral length on the correlation between the Q-tip test and descent at point Aa of the POP-Q system

Larrieux

Balgobin

2007

Int Urogynecol J

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The objective of this study is to evaluate the effect of anatomic urethral length on the relationship between descent at point Aa of the pelvic organ prolapse quantification (POP-Q) system and the Q-tip straining angle. The records of 323 patients who were evaluated for urinary incontinence were reviewed. Prolapse staging was performed using the POP-Q system. Urethrovesical junction hypermobility defined as a maximal straining angle > or =30 degrees was assessed with the Q-tip test. Urethral length was measured with a urethral profilometer. A substantial correlation was found between descent at point Aa and the straining Q-tip angle (r = 0.65, p < 0.0001). There was no correlation between the anatomic urethral length and straining Q-tip angle (r = -0.01, p = 0.8). Urethral length does not affect the straining Q-tip angle. Point Aa is a strong predictor of an abnormal straining Q-tip angle in women with stage I anterior vaginal wall prolapse or greater.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Effect of anatomic urethral length on the correlation between the Q-tip test and descent at point Aa of the POP-Q system

Larrieux

Balgobin

2007

Int Urogynecol J

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“…This is characterized using the pelvic organ prolapse quantification (POP-Q) system, although the reliability of such measurements to identify hypermobility has been demonstrated inconsistent in women without significant prolapse. 13,14 At least one recent report concluded that the Q-tip test is superior to the POP-Q for such evaluation. 6 To our knowledge, the pain associated with this common office procedure has never been noted nor quantified in the literature prior to the current report.…”

Section: Discussionmentioning

confidence: 98%

Prospective Randomized Controlled Trial of Modified Hypermobility Test for Urinary Incontinence

Jones

Vasavada

Rackley

2007

Journal of Pelvic Medicine and Surgery

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Objectives: The Q-tip test is a simple method to quantify urethral mobility, but it is not universally accepted due to discomfort. We sought to lessen this by covering the rough surface with the finger of a latex glove.Methods: The Q-tip test was performed on 60 women presenting for incontinence. Group A consisted of patients who underwent the test using a sterile Q-tip liberally lubricated. Group B patients underwent the procedure using the same type Qtip covered with a finger cut from a latex examination glove.Results: Patients who underwent the modified Qtip test experienced on average less than half as much discomfort (mean VAS, 18) as those who had the test performed in traditional fashion (mean VAS, 41, P < 0001). Similar findings were noted in both premenopausal and postmenopausal women. No complications (including urinary tract infection) were identified.Conclusions: The pain associated with this common procedure has never been noted nor quantified in the literature prior to the current report. Although some patients will still experience pain, physicians who use the Q-tip test can significantly reduce roughness and subsequent discomfort by the modification described.

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“…However, existing data have shown good correlation between urethral hypermobility and advanced prolapse, such as beyond the hymen (93-100%). 3-5, 10 Second, the tests were performed only by urogynecologists. However, the vaginal test is easily performed by inserting a cotton-tipped swab into the vagina in the midline with no other special tasks required.…”

Section: Discussionmentioning

confidence: 99%

Vaginal Swab Test Compared With the Urethral Q-tip Test for Urethral Mobility Measurement

Meyer

Szychowski

Illston

et al. 2016

Obstetrics & Gynecology

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Objective To assess whether a vaginal cotton-tipped swab is equivalent to the standard Q-tip test regarding urethral mobility. Secondarily, to examine whether both tests agree in hypermobility diagnosis, discomfort level, and patients' preference. Methods In this randomized cross-over trial, women with stress urinary incontinence without prolapse beyond the hymen were randomized to undergo either a vaginal or urethral mobility test first followed by the alternate approach. The primary outcome was the difference in rotation angle, from resting to maximum strain, between tests. The equivalence margin was ±10°. The secondary outcome was agreement in hypermobility diagnosis using two definitions, #1 maximum straining angle of ≥30° from the horizontal plane, #2 rotation angle ≥30°. Discomfort was assessed using 0-10 visual analog scale. Using 90% power assuming a standard deviation of 20°, 36 and 139 patients were needed for 10° and 5° equivalence margins, respectively. Results From January 2014 to March 2015, 140 women were randomized. The mean difference between the two tests was 5.1° (95% confidence interval 3.2-6.9°), meeting the predefined equivalence criteria. In the hypermobility diagnosis, the urethral and vaginal tests had no disagreement using the definition #1 (p=0.23) whereas the two tests disagreed using definition #2 (p=0.03). The urethral approach had a higher discomfort level (p<0.001). The majority preferred the vaginal test (68% preferred vaginal, 32% no preference). Conclusion The vaginal swab test is equivalent to the standard Q-tip test in measuring urethral mobility with less discomfort and is preferred by patients.

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Does pelvic organ prolapse quantification exam predict urethral mobility in stages 0 and I prolapse?

Abstract: The POP-Q system is highly predictive of straining urethral angle in all stages of prolapse.

Cited by 23 publications

References 5 publications

Effect of anatomic urethral length on the correlation between the Q-tip test and descent at point Aa of the POP-Q system

Effect of anatomic urethral length on the correlation between the Q-tip test and descent at point Aa of the POP-Q system

Prospective Randomized Controlled Trial of Modified Hypermobility Test for Urinary Incontinence

Vaginal Swab Test Compared With the Urethral Q-tip Test for Urethral Mobility Measurement

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