title: Can urethral mobility be assessed using the pelvic organ prolapse quantification system? An analysis of the correlation between point Aa and Q-tip angle in varying stages of prolapse.
abstract: OBJECTIVE
  To determine whether the Pelvic Organ Prolapse-Quantification (POP-Q) system can be used as a replacement for Q-tip testing to assess urethral mobility in women.
  
  
  METHODS
  We performed a retrospective review of a clinical database of 1490 patients presenting to a urogynecology clinic. The evaluation included both Q-tip straining angle and POP-Q examination. Urethral hypermobility was defined by the Q-tip test as a straining angle of 30 degrees or greater relative to the horizontal. The correlation between point Aa of the POP-Q system and the maximal Q-tip straining angle was determined using the Spearman correlation coefficient.
  
  
  RESULTS
  The mean age of the 1490 patients was 59.5 +/- 13.1 years; the median parity was 2. A total of 62 patients (4.2%) reported prior surgery for incontinence or prolapse. The mean Q-tip straining angle was 44.7 degrees +/- 21.8 degrees. The point Aa values were +3 to -3 cm (median -2). The correlation coefficient between the Q-tip straining angle and point Aa was 0.54 (P <0.001). Urethral hypermobility was observed in 93.3% patients with stage 3 prolapse, 92.5% with stage 2, 88.9% with stage 1, and 55.8% with stage 0. Only in patients with stage 4 prolapse was urethral hypermobility observed 100% of the time.
  
  
  CONCLUSIONS
  The correlation between point Aa of the POP-Q and the Q-tip straining angle was moderately strong when analyzed across all degrees of prolapse. However, urethral hypermobility could not be reliably predicted from POP-Q measurement alone. Therefore, the Q-tip test remains an essential part of the urogynecologic evaluation.
authors.affiliation: Department of Urology, Naval Medical Center San Diego, San Diego, California, USA.
authors.forename: Meredith E
authors.initials: ME
authors.lastname: Mattison
authors.forename: Amanda J
authors.initials: AJ
authors.lastname: Simsiman
authors.forename: Shawn A
authors.initials: SA
authors.lastname: Menefee
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003950:Diagnostic Techniques, Urological; D018450:Disease Progression; D005260:Female; D006801:Humans; D008875:Middle Aged; D011391:Prolapse; D012189:Retrospective Studies; D014521:Urethra / Q000503:physiopathology*; D014522:Urethral Diseases / Q000503:physiopathology*; D014596:Uterine Prolapse / Q000503:physiopathology*