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Obstetrics & Gynecology 2005;105:115-119
© 2005 by The American College of Obstetricians and Gynecologists
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ORIGINAL RESEARCH

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

Karen Tapp, MD, AnnaMarie Connolly, MD and Anthony G. Visco, MD

From the Division of Urogynecology/Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina.

Address reprint requests to: AnnaMarie Connolly, MD, Division of Urogynecology/Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, 4036 Old Clinic Building, CB #7570, Chapel Hill, NC 27599–7570; e-mail: amc004{at}med.unc.edu.

OBJECTIVE: To compare the predictive abilities of the Aa point of the pelvic organ prolapse quantification examination and the cotton-tipped swab test straining angle to diagnose urodynamic stress incontinence.

METHODS: A case-control study was conducted between June 1997 and February 2003. Cases were defined as patients with urodynamic stress incontinence (n = 352). Controls were patients who also underwent urodynamic testing but who did not have a diagnosis of urodynamic stress incontinence (n = 245). Independent variables were defined as Aa point, Aa point of 0 or greater, straining cotton-tipped swab angle, and straining cotton-tipped swab angle of 30° or greater. Logistic regression estimated the odds ratio of stress incontinence in women based on Aa values and cotton-tipped swab straining angle measurements, controlling for other variables commonly associated with stress incontinence.

RESULTS: The mean (± standard deviation) age of the cases was 55.9 ± 13.4 and of controls was 55.3 ± 14.8, (P = .6). The median parity of the cases was 2 (range 0–10) and of controls, 2 (range 0–9) (P = .7). The Aa point was not associated with a diagnosis of stress incontinence (odds ratio 1.01, 95% confidence interval (CI) 0.83–1.23). The adjusted odds ratios of having an Aa value of 0 or greater was 0.49 (95% CI 0.26–0.92), and of having a cotton-tipped swab angle of 30° or greater was 3.1 (95% CI 1.09–5.07), in a model that adjusted for age, parity, race, and postmenopausal and hormonal replacement status.

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

LEVEL OF EVIDENCE: II-2






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