This study aimed to compare measurements of urethral pressure profile and Valsalva leak point pressure (VLPP) obtained with air-charged and microtransducer catheters. Forty-five women with urogynecologic dysfunction underwent multichannel urodynamic evaluation including maximum urethral closure pressure (MUCP), functional urethral length (FUL), and VLPP with air-charged balloon catheters as well as microtransducer catheters. Lin's concordance coefficient was used to examine the agreement of MUCP, VLPP, and FUL measurements with the two catheters. The MUCPs measured with the two catheters had a high concordance coefficient of 0.69 (95% CI 0.50, 0.82). The VLPP measurements obtained with the catheters also agreed well, with a concordance coefficient of 0.71 (95% CI 0.43, 0.87). The measurements of mean FUL had a low concordance of 0.35 (95% CI 0.085, 0.57). Overall, air-charged and microtransducer catheters yield similar information when evaluating VLPP and MUCP. There were differences in FUL and these were likely due to different catheter diameters.

Gynecologists commonly perform rectocele repairs to address a herniation of the rectum into the posterior vaginal wall which results in a vaginal bulge. Women with rectoceles generally complain of perineal and vaginal pressure, obstructive defecation, constipation, and the need to splint or digitally reduce the vagina in order to effectuate a bowel movement. Rectoceles arise from either a tear or stretching of the rectovaginal fascia, and are commonly repaired by gynecologists via a posterior colporrhaphy. Although there are high rates of anatomic cures, there are conflicting reports with regard to functional outcome and many report postoperative dyspareunia. A modified repair, the discrete fascial defect repair, shows promising anatomical and functional results.Objective: On completion of this article the reader should understand the gynecologic approach to evaluation and management of rectoceles.

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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 degrees, interquartile range 25-65, versus 68 degrees, interquartile range 45-75; P <.001). With a full bladder, similar but lesser results were obtained (33 degrees, interquartile range 15-55 [reduced] versus 48 degrees, 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 degrees (interquartile range 25-65) with an empty bladder versus 33 degrees (interquartile range 15-55) with a full bladder (P <.001). Without the prolapse reduced, the median Q-tip angle was 68 degrees (interquartile range 45-75) with an empty bladder and 48 degrees (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.

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