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Effect of Genital Prolapse on Assessment of Bladder Neck Mobility by the Q-tip Test

Pollak, Jennifer T. MD; Jenkins, Penny ARNP; Kopka, Stacy L. MS; Davila, G. Willy MD

Original Research

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°, interquartile range 25–65, versus 68°, interquartile range 45–75; P < .001). With a full bladder, similar but lesser results were obtained (33°, interquartile range 15–55 [reduced] versus 48°, 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° (interquartile range 25–65) with an empty bladder versus 33° (interquartile range 15–55) with a full bladder (P < 001). Without the prolapse reduced, the median Q-tip angle was 68° (interquartile range 45–75) with an empty bladder and 48° (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.

In women with severe pelvic organ prolapse, measured Q-tip angles are significantly affected by the reduction of vaginal prolapse.

Cleveland Clinic Florida, Fort Lauderdale, Florida.

Address reprint requests to: G. Willy Davila, MD, Cleveland Clinic Florida, 2950 Cleveland Clinic Boulevard, Weston, FL 33331; E-mail:

Received April 4, 2002. Received in revised form July 1, 2002. Accepted August 22, 2002.

© 2003 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.