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

Oleh:

Zyczynski, Halina M. ; Lloyd, L. Keith ; Kenton, Kimberly ; Menefee, Shawn ; Boreham, Muriel ; and Others

Jenis: Article from Journal - ilmiah internasional
Dalam koleksi: Obstetrics and Gynecology vol. 110 no. 01 (Jul. 2007), page 39.

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Perpustakaan FK Nomor Panggil: O01.K.2007.03 Non-tandon: 1 (dapat dipinjam: 0) Tandon: tidak ada

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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.

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