title: Effect of genital prolapse on assessment of bladder neck mobility by the Q-tip test.
abstract: OBJECTIVE
  To investigate the effect of vaginal prolapse and bladder fullness on Q-tip test assessment of urethral mobility.
  
  
  METHODS
  Twenty-six women with genital prolapse to or beyond the hymen and undergoing urodynamics for urogynecologic dysfunction were assessed by the Q-tip test. Measurements were obtained with the bladder empty, with and without the prolapse reduced by the posterior blade of a Graves speculum. Angles were repeated at bladder capacity. Measured Q-tip angles were compared using the Wilcoxon signed rank test.
  
  
  RESULTS
  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.
authors.affiliation: Cleveland Clinic Florida, Fort Lauderdale, Florida 33331, USA.
authors.forename: Jennifer T
authors.initials: JT
authors.lastname: Pollak
authors.forename: Penny
authors.initials: P
authors.lastname: Jenkins
authors.forename: Stacy L
authors.initials: SL
authors.lastname: Kopka
authors.forename: G Willy
authors.initials: GW
authors.lastname: Davila
mesh_terms: D005260:Female; D006801:Humans; D008875:Middle Aged; D010808:Physical Examination / Q000379:methods / Q000592:standards*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D014521:Urethra / Q000503:physiopathology*; D014550:Urinary Incontinence, Stress / Q000175:diagnosis* / Q000503:physiopathology; D014563:Urodynamics; D014596:Uterine Prolapse / Q000175:diagnosis* / Q000503:physiopathology