Relationship Between Q-tip Test and Urethral Hypermobility
Condition: Urodynamic Stress Incontinence
MeSH terms: Urinary Incontinence, Stress
Study type: Observational

Summary: 
      Q-tip test was applied for evaluation of urethral hypermobility (UH) in stress-incontinent
      women. It is still unknown whether there is an alternative method for the assessment of UH in
      a less invasive way or not.

      We aim to assess the correlation between the overall rest-stress distance measured by
      transperineal ultrasound (TPUS) and Q-tip test angle in women with urodynamic stress
      incontinence (USI) scheduled for mid-urethral sling surgery (MUS), and determine a cut off
      value of rest-stress distance for predicting UH.
    

Detailed description: 
      Between January 2009 and January 2014, women with urodynamic stress incontinence (USI)
      scheduled for mid-urethral sling surgery in the urogynecological department of a tertiary
      referral center were recruited. A retrospective chart review was performed. This study
      received approval from the Institutional Review Board of Kaohsiung Medical University
      Hospital (ID:KMUHIRB-E(I)-20210275), by which relevant guidelines and regulations were
      followed accordingly. Informed consent was obtained from all participants before surgeries.
      The Q-tip test was performed via a cotton swab with the patient in a 45-degree reclining.
      After lubricated with 2% lidocaine jelly, the cotton swab was inserted with the tip over
      bladder neck. The angle changes from rest to maximal straining were obtained for 3 times, and
      the maximum of angle change was recorded. The TPUS was performed by two experienced
      urogynecologist according to KMUH-TPUS protocol. The Voluson General Electric Sonography,
      expert 730 type (GE, Healthcare Ultrasound, Zipf, Austria) Ultrasonography was used with 3.5
      MHZ curved linear-array transducer placed between the major labia and underneath the external
      urethral orifice. The measurement was done on the midsagittal plane to obtain the image of
      pubic symphysis, urethra, and bladder in a view. Ultrasonic measurement of the overall
      rest-stress distance was define as the linear distance of bladder neck position change from
      resting status to maximal strain. The rest-stress distance was obtained for 3 times, and the
      maximum of distance was recorded. The primary outcome of this study was the correlation
      between the angle of Q-tip test and the overall rest-stress distance of bladder neck in TPUS.
      The secondary outcome was the optimal cut off value of the rest-stress distance to predict
      UH.
    

Intervention name(s): Transperineal ultrasound
Intervention type(s): Diagnostic Test
Intervention description(s): Ultrasonography was used with curved linear-array transducer placed between the major labia and underneath the external urethral orifice. The measurement was done on the midsagittal plane to obtain the image of pubic symphysis, urethra, and bladder in a view. Ultrasonic measurement of the overall rest-stress distance was define as the linear distance of bladder neck position change from resting status to maximal strain.
Observational model: Cohort
Time perspective: Retrospective
Sampling method: Non-Probability Sample
Study population: 
        Between January 2009 and January 2014, a total of 258 women with urodynamic stress
        incontinence (USI) scheduled for mid-urethral sling surgery in the urogynecological
        department of a tertiary referral center were recruited. A retrospective chart review was
        performed. Women with more or equal to stage 2 pelvic organ prolapse (POP) defined by
        POP-quantification system (POP-Q) and received concomitant transvaginal mesh (TVM) surgery
        were excluded. Women with incomplete ultrasound records were also excluded.
      
Keywords: Urodynamic stress incontinence; Q-tip test; Transperineal ultrasound; Urethral hypermobility