Effect of genital prolapse on assessment of bladder neck mobility by the Q-tip test

Pollak, Jennifer T.; Jenkins, Penny; Kopka, Stacy L.; Davila, G. Willy

doi:10.1016/s0029-7844(03)00067-x

Cited by 10 publications

(4 citation statements)

References 9 publications

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“… Q-tip angle: one study concluded that the Q-tip test is affected by POP. The angles were smaller with the prolapse reduced and with a full bladder [ 64 ]. A substantial correlation (r=0.68) between POP-Q point Aa and Q-tip angle was noted in a study on women presenting predominantly with SUI and anterior wall prolapse [ 65 ].…”

Section: Resultsmentioning

confidence: 99%

International Urogynecology consultation chapter 2 committee 3: the clinical evaluation of pelvic organ prolapse including investigations into associated morbidity/pelvic floor dysfunction

Barbier,

Carberry,

Karjalainen

et al. 2023

Int Urogynecol J

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Introduction and hypothesis This manuscript from Chapter 2 of the International Urogynecology Consultation (IUC) on Pelvic Organ Prolapse (POP) reviews the literature involving the clinical evaluation of a patient with POP and associated bladder and bowel dysfunction. Methods An international group of 11 clinicians performed a search of the literature using pre-specified search MESH terms in PubMed and Embase databases (January 2000 to August 2020). Publications were eliminated if not relevant to the clinical evaluation of patients or did not include clear definitions of POP. The titles and abstracts were reviewed using the Covidence database to determine whether they met the inclusion criteria. The manuscripts were reviewed for suitability using the Specialist Unit for Review Evidence checklists. The data from full-text manuscripts were extracted and then reviewed. Results The search strategy found 11,242 abstracts, of which 220 articles were used to inform this narrative review. The main themes of this manuscript were the clinical examination, and the evaluation of comorbid conditions including the urinary tract (LUTS), gastrointestinal tract (GIT), pain, and sexual function. The physical examination of patients with pelvic organ prolapse (POP) should include a reproducible method of describing and quantifying the degree of POP and only the Pelvic Organ Quantification (POP-Q) system or the Simplified Pelvic Organ Prolapse Quantification (S-POP) system have enough reproducibility to be recommended. POP examination should be done with an empty bladder and patients can be supine but should be upright if the prolapse cannot be reproduced. No other parameters of the examination aid in describing and quantifying POP. Post-void residual urine volume >100 ml is commonly used to assess for voiding difficulty. Prolapse reduction can be used to predict the possibility of postoperative persistence of voiding difficulty. There is no benefit of urodynamic testing for assessment of detrusor overactivity as it does not change the management. In women with POP and stress urinary incontinence (SUI), the cough stress test should be performed with a bladder volume of at least 200 ml and with the prolapse reduced either with a speculum or by a pessary. The urodynamic assessment only changes management when SUI and voiding dysfunction co-exist. Demonstration of preoperative occult SUI has a positive predictive value for de novo SUI of 40% but most useful is its absence, which has a negative predictive value of 91%. The routine addition of radiographic or physiological testing of the GIT currently has no additional value for a physical examination. In subjects with GIT symptoms further radiological but not physiological testing appears to aid in diagnosing enteroceles, sigmoidoceles, and intussusception, but there are no data on how this affects outcomes. There were no articles in the search on the evaluation of the co-morbid conditions of pain or sexual dysfunction in women with POP. Conclusions The clinical pelvic examination remains the central tool for evaluation of POP and a system such as the POP-Q or S-POP should be used to describe and quantify. The value of investigation for urinary tract dysfunction was discussed and findings presented. The routine addition of GI radiographic or physiological testing is currently not recommended. There are no data on the role of the routine assessment of pain or sexual function, and this area needs more study. Imaging studies alone cannot replace clinical examination for the assessment of POP.

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Section: Resultsmentioning

confidence: 99%

International Urogynecology consultation chapter 2 committee 3: the clinical evaluation of pelvic organ prolapse including investigations into associated morbidity/pelvic floor dysfunction

Barbier,

Carberry,

Karjalainen

et al. 2023

Int Urogynecol J

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“…In the diagnosis of SUI, besides a thorough clinical examination, the evaluation of bladder neck mobility is performed using complementary diagnostic techniques such as the Q-tip test [6], cystourethrography [7], and imaging of the pelvic floor via transperineal ultrasound (US) [8,9,10].…”

Section: Introductionmentioning

confidence: 99%

Transperineal Ultrasound Assessment of a Cystocele’s Impact on the Bladder Neck Mobility in Women with Stress Urinary Incontinence

et al. 2019

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Background and objectives: As pelvic floor disorders are often difficult to assess thoroughly based on clinical examination alone, the use of imaging as a complementary technique is helpful. This study’s aim was to investigate by transperineal ultrasound (US) if there was any significant difference in the mobility of the bladder neck in women with stress urinary incontinence (SUI) without a cystocele and in those with SUI and an associated cystocele. The study also investigated whether the number of vaginal births and/or the heaviest newborn’s birth weight was correlated with the bladder neck mobility. Materials and Methods: A total of 71 women suffering from SUI were included in the study and divided into two groups based on the presence of a cystocele. Their bladder neck mobility was evaluated by transperineal US, calculating the distance from the inferior margin of the symphysis pubis to the bladder neck (SPBN), and the dorsocaudal linear movement (DLM), term used to illustrate the displacement of the bladder neck by subtracting rest and Valsalva values. GraphPad Prism 8 was used for statistical analysis. Results: Within both study groups, the SPBN values were significantly higher and the DLM values were significantly lower at rest as compared to Valsalva maneuver (p < 0.05). No significant difference between the groups regarding SPBN and DLM values at rest, Valsalva, or subtraction was demonstrated. A significant positive correlation was found between the bladder neck mobility and the heaviest newborn’s birth weight, regardless of the presence of a cystocele (p = 0.042). Conclusions: The presence of a cystocele had no significant impact on the bladder neck mobility measurements in patients with SUI. The heaviest newborn’s birth weight positively correlated with bladder neck hypermobility, as quantified by SPBN.

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“…UH is commonly underlying stress UI, and has been used as a diagnostic tool, a prognostic factor and a preoperative criterion for anti‐incontinence procedures . There are several methods for UH assessment, but the most commonly used, simple, reliable and inexpensive method has long been the Q‐tip test .…”

Section: Introductionmentioning

confidence: 99%

“…UH is commonly underlying stress UI, and has been used as a diagnostic tool, a prognostic factor and a preoperative criterion for anti-incontinence procedures. [1][2][3][4][5][6][7][8][9] There are several methods for UH assessment, but the most commonly used, simple, reliable and inexpensive method has long been the Q-tip test. 1,3,4,6,10,11 It was introduced in 1971, 12 and the value of 30°above the horizontal has largely been accepted as the cut-off point for UH.…”

Section: Introductionmentioning

confidence: 99%

Anterior compartment descent: A new measure in the assessment of urethral hypermobility in women with urinary incontinence

Serdinšek

But

2017

Int J of Urology

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Effect of genital prolapse on assessment of bladder neck mobility by the Q-tip test

Cited by 10 publications

References 9 publications

International Urogynecology consultation chapter 2 committee 3: the clinical evaluation of pelvic organ prolapse including investigations into associated morbidity/pelvic floor dysfunction

International Urogynecology consultation chapter 2 committee 3: the clinical evaluation of pelvic organ prolapse including investigations into associated morbidity/pelvic floor dysfunction

Transperineal Ultrasound Assessment of a Cystocele’s Impact on the Bladder Neck Mobility in Women with Stress Urinary Incontinence

Anterior compartment descent: A new measure in the assessment of urethral hypermobility in women with urinary incontinence

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