Present value of the Urethral mobility test as a tool to assess Stress urinary incontinence due to Intrinsic sphincteric deficiency

Abstract

Q-tip test offers a simple approach for identifying urethral hypermobility. Considering surgical treatment, stress urinary incontinence (SUI) must be classified and the contribution of intrinsic sphincter deficiency (ISD) and/or urethral hypermobility must be determine. We believe there's a correlation between abdominal leak point pressure (ALPP) and urethral mobility degree, and the aim of this study is to explore it using Q-tip. We conducted a prospective study, between years 2014 and 2016. Females over 18 years presenting with signs and symptoms of SUI according to the 2002 ICS Standardization of Terminology were included. Assessment was made with the International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF), the Q-tip test and invasive urodynamics. Urethral mobility (UM) and ALPP were analyzed. We built two composite variables based on reported risk factors for ISD, defined as composite variable A (equal to a Q-tip test < 30° AND ICIQ-SF ≥ 10 points) and composite variable B (equal to low urethral mobility AND/OR hypoestrogenism AND/OR history of radiotherapy AND/OR previous pelvic surgery). Correlation analyzes were made according to the type of variable. A total of 221 patients were included. Incontinence was rated as moderate and severe by 65.3% and 6.8%, respectively. The analysis showed a 61.75%, 51.61% and 70.6% agreement between ALPP and UM, ALPP and composite variable A and ALPP and composite variable B respectively. Correlation and concordances were low (r = 0.155, r_s = − 0.053 and r_s = − 0.008), (rho_c = 0.036, k = 0.116 and k = 0.016). Neither the degree of UM, nor the composite variables, correlate or agree with urethral function tests in UDS, suggesting that the ALPP cannot be predicted using the Q-tip test or the ICIQ-SF for classifying patients with SUI.

Relationship between Q-Tip Test and Urethral Hypermobility on Perineal Ultrasound

“…Results demonstrated a 61.75%, 51.61%, and 70.6% agreement between ALPP and urethral mobility (UM), ALPP and composite A (equal to a Q-tip test < 30 • AND ICIQ-SF ≥ 10 points), and ALPP and composite variable B (equal to low urethral mobility, AND/OR hypoestrogenism, AND/OR history of radiotherapy, AND/OR previous pelvic surgery), respectively. The authors found that neither the degree of UM, nor the composite variables, correlated or agreed with urethral function tests in UDS, which suggested that the ALPP cannot be predicted using the Q-tip test or the ICIQ-SF for classifying patients with SUI [29]. However, Ohter study in 2022 intended to evaluate the use of transperineal ultrasonography while diagnosing SUI by comparing the urethral angle (α), posterior urethrovesical angle (β), and bladder-neck descent (BND) during rest and Valsalva maneuver in continent women and women with SUI.…”

Effectiveness of Laser Therapy in perimenopausal and Postmenopausal Stress Urinary Incontinence

“…ALPP < 60 cm H2O meaning the diagnostic value of type III SUI (ISD), an ALPP between (90-120) cm H2O is considered diagnostic of type II SUI (HMU), while ALPP between (60-90) cm H2O indicate the presence of both type II and type III . 12 Detrusor instability is diagnosed when the true detrusor pressure increased or even when smaller increases cause urgency or incontinence during urodynamic. 13 Mixed urinary incontinence" (stress and urge) is a combination of urodynamic conditions (urodynamic stress incontinence and detrusor over activity) in the same individual .…”