Evaluation of Aa Point and Cotton-Tipped Swab Test as Predictors of Urodynamic Stress Incontinence

Abstract

Aa point is not associated with a diagnosis of stress incontinence. However, a cotton-tipped swab angle of 30 degrees or greater is positively associated with stress incontinence.

Pelvic organ prolapse and the lower urinary tract: The Relationship of vaginal prolapse to stress urinary incontinence

“…However, a higher prevalence of urodynamic SUI has been found among users of postmenopausal hormone therapy [12], consistent with previous symptom-based reports [27,28]. Zhu et al [29] found estrogen α-receptor concentration to be independent of estrogenization status, whereas β-receptors are sensitive to estrogen levels.…”

“…For predicting urodynamic SUI, the Q-tip test was found to have a sensitivity of 80% and a specificity of 42% compared with POP-Q point Aa, which had a sensitivity of 37% and a specificity of 58% [12]. Both of these findings suggest that neither Q-tip testing nor POP-Q point Aa assessment are of great value in predicting urodynamic SUI.…”

“…Approximately one to two thirds of women with POP at or beyond the introitus who do not demonstrate SUI will have SUI upon repair of their prolapse. Patients with point Aa at 0 or greater were found to have a 51% reduced risk of having urodynamic SUI [12].…”

“…Sze et al [11] reported that white women were more likely to report urinary incontinence and stress incontinence symptoms than black or Hispanic women, although urge-related symptomatology was similar among all three groups. Black women were only approximately half as likely to suffer from urodynamic SUI when compared with other racial groups [12]. In a chart review of patients who had undergone surgery for POP, Strohbehn et al [13] found a higher prevalence of connective tissue diseases, recognized nerve damage, and congenital abnormalities in women under age 35 when compared with older women.…”

“…Hypermobility, as assessed by cotton-swab examination, does not have good predictive value for the presence of incontinence [12,25,44,45], but this could be due to failure of the test itself rather than failure of a physiologic model.…”