Abstract

Q-tip test offers a simple approach for identifying urethral hypermobility. Considering surgical treatment, stress urinary incontinence (SUI) must be classified and the contribution of intrinsic sphincter deficiency (ISD) and/or urethral hypermobility must be determine. We believe there’s a correlation between abdominal leak point pressure (ALPP) and urethral mobility degree, and the aim of this study is to explore it using Q-tip. We conducted a prospective study, between years 2014 and 2016. Females over 18 years presenting with signs and symptoms of SUI according to the 2002 ICS Standardization of Terminology were included. Assessment was made with the International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF), the Q-tip test and invasive urodynamics. Urethral mobility (UM) and ALPP were analyzed. We built two composite variables based on reported risk factors for ISD, defined as composite variable A (equal to a Q-tip test < 30° AND ICIQ-SF ≥ 10 points) and composite variable B (equal to low urethral mobility AND/OR hypoestrogenism AND/OR history of radiotherapy AND/OR previous pelvic surgery). Correlation analyzes were made according to the type of variable. A total of 221 patients were included. Incontinence was rated as moderate and severe by 65.3% and 6.8%, respectively. The analysis showed a 61.75%, 51.61% and 70.6% agreement between ALPP and UM, ALPP and composite variable A and ALPP and composite variable B respectively. Correlation and concordances were low (r = 0.155, r_s = – 0.053 and r_s = – 0.008), (rho_c = 0.036, k = 0.116 and k = 0.016). Neither the degree of UM, nor the composite variables, correlate or agree with urethral function tests in UDS, suggesting that the ALPP cannot be predicted using the Q-tip test or the ICIQ-SF for classifying patients with SUI.

Conflict of interest statement

The authors declare no competing interests.

Figures

Figure 1

Similar articles

See all similar articles

References

    1. Abrams P, Cardozo L, Fall M, et al. The standardisation of terminology of lower urinary tract function: report from the Standardisation Sub-committee of the International Continence Society. Neurourol. Urodyn. 2002;21:167–178. doi: 10.1002/nau.10052. – DOI – PubMed
    1. de Toledo LGM, Cabral PHO, Casella ML, Politi GE, Cardoso SN, Mello LF, et al. Prognostic value of urethral mobility and valsalva leak point pressure for female transobturator sling procedure. Int. Braz. J. Urol. 2012;38:667–673. doi: 10.1590/S1677-55382012000500012. – DOI – PubMed
    1. Walters MSL. The diagnostic value of history, physical examination, and the Q-tip cotton swab test in women with urinary incontinence. Am. J. Obs. Gynecol. 1988;159:145–149. doi: 10.1016/0002-9378(88)90510-8. – DOI – PubMed
    1. Chen Y, Wen JG, Shen H, et al. Valsalva leak point pressure-associated Q-tip angle and simple female stress urinary incontinence symptoms. Int. Urol. Nephrol. 2014;46:2103–2108. doi: 10.1007/s11255-014-0772-4. – DOI – PubMed
    1. Kohorn EI. Negative Q-tip test as a risk factor for failed incontinence surgery in women. J. Reprod. Med. 1990;35:193. – PubMed
    1. Leach GE, Dmochowski RR, Appell RA, et al. Female Stress Urinary Incontinence Clinical Guidelines Panel summary report on surgical management of female stress urinary incontinence. Am. Urol. Assoc. 1997;158:875–880. – PubMed
    1. Yande SD, Joglekar OV, Joshi M. Role of urodynamics in stress urinary incontinence: a critical appraisal. J. Midlife Health. 2016;7:119–125. doi: 10.4103/0976-7800.191016. – DOI – PMC – PubMed
    1. Hickling DR, Steele SS. The role of preoperative urodynamics in stress urinary incontinence surgery. Can. Urol. Assoc. J. 2017;11:S113–S115. doi: 10.5489/cuaj.4581. – DOI – PMC – PubMed
    1. Kobashi K, Albo M, Dmochowski R, Ginsberg D, Ho G, Gomelsky A, et al. American Urologic Association Stress-Urinary-Incontinence guideline. J. Urol. 2017;198:875–883. doi: 10.1016/j.juro.2017.06.061. – DOI – PubMed
    1. Chung HS, Kim SOKDU. Urethral mobility and point Aa of the Pelvic Organ Prolapse Quantification (POP-Q) system before and after midurethral sling operation. LUTS Low Urin. Tract Symptoms. 2019;11:O117–O120. doi: 10.1111/luts.12228. – DOI – PubMed
    1. Serdinšek TBI. Anterior compartment descent: a new measure in the assessment of urethral hypermobility in women with urinary incontinence. Int. J. Urol. 2017;24:548–552. doi: 10.1111/iju.13370. – DOI – PubMed
    1. Haylen BT, de Ridder D, Freeman RM. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Neurourol. Urodyn. 2010;798:797–798. doi: 10.1002/nau. – DOI – PubMed
    1. Rosier PFWM, Schaefer W, Lose G, et al. International continence society good urodynamic practices and terms 2016: Urodynamics, uroflowmetry, cystometry, and pressure-flow study. Neurourol. Urodyn. 2017;36:1243–1260. doi: 10.1002/nau.23124. – DOI – PubMed
    1. Bump RC, Mattiasson A, Bo K, et al. The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. Am. J. Obstet. Gynecol. 1996;175:10–17. doi: 10.1016/S0002-9378(96)70243-0. – DOI – PubMed
    1. Schfer W, Abrams P, Liao L, et al. Good urodynamic practices: uroflowmetry, filling cystometry, and pressure-flow studies. Neurourol. Urodyn. 2002;21:261–274. doi: 10.1002/nau.10066. – DOI – PubMed
    1. Blavais JGOC. Stress incontinence: classification and surgical approach. J. Urol. 1988;39:727–731. doi: 10.1016/S0022-5347(17)42611-5. – DOI – PubMed
    1. Linda C, David SP, Mauricio FN, Osborn D, Dmochowsky R. How and Why Incontinence Surgery Works. Textbook of Female Urology and Urogynecology. 4. Boca Raton: CRC Press; 2017.
    1. Abrams P, Hilton P, Lucas MST. A proposal for a new classification for operative procedures for stress urinary incontinence. BJU Int. 2005;96:232–233. doi: 10.1111/j.1464-410X.2005.05607.x. – DOI – PubMed
    1. Mcguire EJ, Fitzpatrick CC, Wan J, et al. Clinical assessment of urethral sphincter functioN. J. Urol. 1993;150:1452–1454. doi: 10.1016/S0022-5347(17)35806-8. – DOI – PubMed
    1. Schick E, Dupont C, Bertrand PE, Jolivet-Tremblay MTJ. Predictive value of maximum urethral closure pressure, urethral hypermobility and urethral incompetence in the diagnosis of clinically significant female genuine stress incontinence. J. Urol. 2004;171:1871–1875. doi: 10.1097/01.ju.0000120224.67012.39. – DOI – PubMed
    1. Iancu GPG. Predicting the outcome of mid-urethral tape surgery for stress urinary incontinence using preoperative urodynamics – a systematic review. Chir. 2014;109:359–368. – PubMed
    1. McGuire EJ. Urodynamic findings in patients after failure of stress incontinence operations. Prog. Clin. Biol. Res. 1981;78:351–360. – PubMed
    1. Crystle CD, Charme LSCW. Q-tip test in stress urinary incontinence. Obstet. Gynecol. 1971;38:313–315. – PubMed
    1. Karram MMBN. The Q-tip test: standardization of the technique and its interpretation in women with urinary incontinence. Obstet. Gynecol. 1988;71:807–811. – PubMed
    1. Swift S, Barnes D, Herron A, Goodnight W. Test-retest reliability of the cotton swab (Q-tip®) test in the evaluation of the incontinent female. Int. Urogynecol. J. 2010;21:963–967. doi: 10.1007/s00192-010-1135-z. – DOI – PubMed
    1. Fritel X, Fauconnier A, Bader G, et al. Diagnosis and management of adult female stress urinary incontinence: guidelines for clinical practice from the French College of Gynaecologists and Obstetricians. Eur. J. Obstet. Gynecol. Reprod. Biol. 2010;151:14–19. doi: 10.1016/j.ejogrb.2010.02.041. – DOI – PubMed
    1. Fritel X, Fauconnier A, Bader G, et al. Diagnosis and management of adult female stress urinary incontinence. Guidelines for clinical practice from the French College of Gynaecologists and Obstetricians (CNGOF) Pelvi-perineologie. 2010;5:195–202. doi: 10.1007/s11608-010-0321-2. – DOI – PubMed
    1. Kreder KJ, Austin JC. Treatment of stress urinary incontinence in women with urethral hypermobility and intrinsic sphincter deficiency. J. Urol. 1996;156:1995–1998. doi: 10.1016/S0022-5347(01)65413-2. – DOI – PubMed
    1. Lemack GE. Clinical and demographic factors associated with valsalva leak point pressure among women undergoing burch bladder neck suspension or autologous rectus fascial sling procedures. Neurourol. Urodyn. 2007;26:392–396. doi: 10.1002/nau.20325. – DOI – PubMed
    1. Albo ME, Steers W, Diokno A, et al. The trial of mid-urethral slings (TOMUS): design and methodology. J. Appl. Res. 2008;8:1–13. doi: 10.1016/j.biotechadv.2011.08.021.Secreted. – DOI – PMC – PubMed
    1. Richter, et al. Retropubic versus transobturator midurethral slings for stress incontinence. N. Engl. J. Med. 2010;362:2066–2076. doi: 10.1056/NEJMoa0912658. – DOI – PMC – PubMed
    1. Ghoniem G, Stanford E, Kenton K, et al. Evaluation and outcome measures in the treatment of female urinary stress incontinence: International Urogynecological Association (IUGA) guidelines for research and clinical practice. Int. Urogynecol. J. 2008;19:5–33. doi: 10.1007/s00192-007-0495-5. – DOI – PMC – PubMed
    1. Fleischmann N, Flisser AJ, Blaivas JG, Panagopoulos G. Sphincteric urinary incontinence: relationship of vesical leak point pressure, urethral mobility and severity of incontinence. J. Urol. 2003;169:999–1002. doi: 10.1097/01.ju.0000051895.28240.12. – DOI – PubMed
    1. de Toledo LGM, Cabral PHO, Casella ML, et al. Prognostic value of urethral mobility and valsalva leak point pressure for female transobturator sling procedure. Int. Braz. J. Urol. 2012;38:667–673. doi: 10.1590/S1677-55382012000500012. – DOI – PubMed