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Obstetrics & Gynecology 2007;110:39-43
© 2007 by The American College of Obstetricians and Gynecologists
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ORIGINAL RESEARCH

Correlation of Q-Tip Values and Point Aa in Stress-Incontinent Women

Halina M. Zyczynski, MD1, L. Keith Lloyd, MD2, Kimberly Kenton, MD, MS3, Shawn Menefee, MD4, Muriel Boreham, MD5, Anne M. Stoddard, ScD6 for the Urinary Incontinence Treatment Network (UITN)*7

From the 1Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania; 2Division of Urology, University of Alabama at Birmingham, Birmingham, Alabama; 3Departments of Obstetrics and Gynecology and Urology, Loyola University Medical Center, Maywood, Illinois; 4Department of Obstetrics and Gynecology, Southern California Permanente Medical Group, San Diego, California; 5Department of Obstetrics and Gynecology, Baylor University Medical Center, Dallas, Texas; 6New England Research Institutes, Watertown, Massachusetts; 7National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland.

OBJECTIVE: To estimate the relationship between pelvic organ prolapse quantification (POP-Q) point Aa and straining Q-tip angle.

METHODS: We compared preoperative straining Q-tip angles and Aa measurements from 655 women with predominant stress incontinence and urethral hypermobility (defined as a resting or straining angle of greater than 30º) using Pearson correlations and linear regression. Point Aa is 3 cm deep to the urethral meatus in the midline of the anterior vagina and corresponds to the urethrovesical crease.

RESULTS: The median for point Aa was –1 cm (range –3 to +3 cm) and for straining Q-tip was 60º (30–130º). Twenty-nine percent of participants had an Aa at least 2 cm deep to the hymen, whereas in 69%, Aa was at or below –1 cm. The straining Q-tip angle was significantly different between these respective groups: 51.5º and 64º (P<.001). Linear regression analysis indicates that point Aa and straining Q-tip were moderately correlated (r=0.35, P<.001). As straining point Aa increased by 1 cm, Q-tip angle increased 4.6º (P<.001). Age and prior anterior vaginal or incontinence surgery had no significant effect on the correlation (P=.08 and P=.64, respectively).

CONCLUSION: Nearly a third of stress-incontinent women with urethral mobility by Q-tip test visually appeared to have a well-supported urethrovesical junction with POP-Q point Aa values of –2 cm or less. The position of the urethrovesical crease (point Aa) on POP-Q and straining angle on Q-tip test do not appear to reflect the same anatomic support and cannot be used to predict one another. No Aa value can rule out urethral hypermobility.

LEVEL OF EVIDENCE: II






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