title: Correlation of Q-tip values and point Aa in stress-incontinent women.
abstract: OBJECTIVE
  To estimate the relationship between pelvic organ prolapse quantification (POP-Q) point Aa and straining Q-tip angle.
  
  
  METHODS
  We compared preoperative straining Q-tip angles and Aa measurements from 655 women with predominant stress incontinence and urethral hypermobility (defined as a resting or straining angle of greater than 30 masculine) using Pearson correlations and linear regression. Point Aa is 3 cm deep to the urethral meatus in the midline of the anterior vagina and corresponds to the urethrovesical crease.
  
  
  RESULTS
  The median for point Aa was -1 cm (range -3 to +3 cm) and for straining Q-tip was 60 masculine (30-130 masculine). Twenty-nine percent of participants had an Aa at least 2 cm deep to the hymen, whereas in 69%, Aa was at or below -1 cm. The straining Q-tip angle was significantly different between these respective groups: 51.5 masculine and 64 masculine (P<.001). Linear regression analysis indicates that point Aa and straining Q-tip were moderately correlated (r=0.35, P<.001). As straining point Aa increased by 1 cm, Q-tip angle increased 4.6 masculine (P<.001). Age and prior anterior vaginal or incontinence surgery had no significant effect on the correlation (P=.08 and P=.64, respectively).
  
  
  CONCLUSIONS
  Nearly a third of stress-incontinent women with urethral mobility by Q-tip test visually appeared to have a well-supported urethrovesical junction with POP-Q point Aa values of -2 cm or less. The position of the urethrovesical crease (point Aa) on POP-Q and straining angle on Q-tip test do not appear to reflect the same anatomic support and cannot be used to predict one another. No Aa value can rule out urethral hypermobility.
authors.affiliation: Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA. hzyczynski@mail.magee.edu
authors.forename: Halina M
authors.initials: HM
authors.lastname: Zyczynski
authors.forename: L Keith
authors.initials: LK
authors.lastname: Lloyd
authors.forename: Kimberly
authors.initials: K
authors.lastname: Kenton
authors.forename: Shawn
authors.initials: S
authors.lastname: Menefee
authors.forename: Muriel
authors.initials: M
authors.lastname: Boreham
authors.forename: Anne M
authors.initials: AM
authors.lastname: Stoddard
mesh_terms: D000328:Adult; D015331:Cohort Studies; D003950:Diagnostic Techniques, Urological; D005260:Female; D006801:Humans; D008875:Middle Aged; D014521:Urethra / Q000033:anatomy & histology / Q000503:physiopathology; D014522:Urethral Diseases / Q000150:complications / Q000175:diagnosis*; D014550:Urinary Incontinence, Stress / Q000175:diagnosis / Q000209:etiology*; D014596:Uterine Prolapse / Q000150:complications / Q000175:diagnosis*