Effect of genital prolapse on assessment of bladder neck mobility by the Q-tip test

Abstract

Objective To investigate the effect of vaginal prolapse and bladder fullness on Q-tip test assessment of urethral mobility. Methods Twenty-six women with genital prolapse to or beyond the hymen and undergoing urodynamics for urogynecologic dysfunction were assessed by the Q-tip test. Measurements were obtained with the bladder empty, with and without the prolapse reduced by the posterior blade of a Graves speculum. Angles were repeated at bladder capacity. Measured Q-tip angles were compared using the Wilcoxon signed rank test. Results Q-tip angles were significantly altered by vaginal prolapse and bladder fullness. With an empty bladder, the median Q-tip angle measured with the prolapse reduced was significantly less than that measured without reduction (53°, interquartile range 25–65, versus 68°, interquartile range 45–75; P < .001). With a full bladder, similar but lesser results were obtained (33°, interquartile range 15–55 [reduced] versus 48°, interquartile range 31–60 [unreduced]; P < .001). The median Q-tip angle with an empty bladder was greater than that with a full bladder. With the prolapse reduced, the Q-tip angle was 53° (interquartile range 25–65) with an empty bladder versus 33° (interquartile range 15–55) with a full bladder ( P < .001). Without the prolapse reduced, the median Q-tip angle was 68° (interquartile range 45–75) with an empty bladder and 48° (interquartile range 31–60) with a full bladder ( P < .001). Conclusion Measurement of urethral mobility by the Q-tip test is significantly affected by genital prolapse. Q-tip angles are less with the reduction of vaginal prolapse and with the bladder full. Standardization of measurement technique is necessary for the development of clinical management recommendations.