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.
Highlights
Female urinary incontinence (UI) is a prevalent condition with substantial impact in patients’ daily activities and their quality of life, and [1], a frequent cause for consultation[2]
Q-tip ability in predicting urodynamic study (UDS) findings is still unclear for the above our aim is to assess the level of correlation and agreement between abdominal leak point pressure (ALPP) and the degree of urethral mobility measured by the Q-tip test in females with stress urinary incontinence (SUI)
Other statistically significant predictive variables were previous UI surgery, presence of urge UI on validated questionnaires and a 10 g pad test w eight[30,31]. Based on these prior results we aimed to find a correlation between ALPP and Q-tip test results that would aid in predicting intrinsic sphincter deficiency (ISD), but, we found that 58.8% of woman with diverse SUI severity had a positive Q-tip test, correlation and concordance between these two variables was poor, even after selecting for severity using high ICIQ-UI scores by creating a composite variable
Summary
Female urinary incontinence (UI) is a prevalent condition with substantial impact in patients’ daily activities and their quality of life, and [1], a frequent cause for consultation[2]. For stress urinary incontinence (SUI) in particular, a distinction must be made to determine the contribution of intrinsic sphincter deficiency (ISD) and/or urethral/bladder neck hypermobility, considering this will guide the treatment and probably its surgical approach[4]. The Q-tip test offers a simple, office-based approach for identifying urethral hypermobility It is performed by introducing a cotton swab through the urethral meatus to the bladder neck, and measuring its displacement with a goniometer during Valsalva maneuver. NICE/UK, French) either do not offer comment or recommend its use it is still considered in American guidelines such as the latest Surgical Treatment of Female Stress Urinary Incontinence (SUI): AUA/SUFU G uideline[9] and we can see on recently published evidence that it is still part of the repertoire of available diagnostic and follow-up tests for stress urinary incontinence for certain study g roups[10,11].
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