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Robledo D, Zuluaga L, Bravo-Balado A, Domínguez C, Trujillo CG, Caicedo JI, Rondón M, Azuero J, Plata M. Present value of the Urethral mobility test as a tool to assess Stress urinary incontinence due to Intrinsic sphincteric deficiency. Sci Rep 2020; 10:20993. [PMID: 33268806 PMCID: PMC7710709 DOI: 10.1038/s41598-020-77493-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 03/12/2020] [Indexed: 11/24/2022] Open
Abstract
Q-tip test offers a simple approach for identifying urethral hypermobility. Considering surgical treatment, stress urinary incontinence (SUI) must be classified and the contribution of intrinsic sphincter deficiency (ISD) and/or urethral hypermobility must be determine. We believe there's a correlation between abdominal leak point pressure (ALPP) and urethral mobility degree, and the aim of this study is to explore it using Q-tip. We conducted a prospective study, between years 2014 and 2016. Females over 18 years presenting with signs and symptoms of SUI according to the 2002 ICS Standardization of Terminology were included. Assessment was made with the International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF), the Q-tip test and invasive urodynamics. Urethral mobility (UM) and ALPP were analyzed. We built two composite variables based on reported risk factors for ISD, defined as composite variable A (equal to a Q-tip test < 30° AND ICIQ-SF ≥ 10 points) and composite variable B (equal to low urethral mobility AND/OR hypoestrogenism AND/OR history of radiotherapy AND/OR previous pelvic surgery). Correlation analyzes were made according to the type of variable. A total of 221 patients were included. Incontinence was rated as moderate and severe by 65.3% and 6.8%, respectively. The analysis showed a 61.75%, 51.61% and 70.6% agreement between ALPP and UM, ALPP and composite variable A and ALPP and composite variable B respectively. Correlation and concordances were low (r = 0.155, r_s = − 0.053 and r_s = − 0.008), (rho_c = 0.036, k = 0.116 and k = 0.016). Neither the degree of UM, nor the composite variables, correlate or agree with urethral function tests in UDS, suggesting that the ALPP cannot be predicted using the Q-tip test or the ICIQ-SF for classifying patients with SUI.
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Affiliation(s)
- Daniela Robledo
- Department of Urology, Hospital Universitario Fundación Santa Fe de Bogotá and Universidad de Los Andes School of Medicine, Carrera 7 No. 118-09, Unidad Renal, piso 3, 110111, Bogotá, D.C., Colombia
| | - Laura Zuluaga
- Department of Urology, Hospital Universitario Fundación Santa Fe de Bogotá and Universidad de Los Andes School of Medicine, Carrera 7 No. 118-09, Unidad Renal, piso 3, 110111, Bogotá, D.C., Colombia
| | - Alejandra Bravo-Balado
- Department of Urology, Hospital Universitario Fundación Santa Fe de Bogotá and Universidad de Los Andes School of Medicine, Carrera 7 No. 118-09, Unidad Renal, piso 3, 110111, Bogotá, D.C., Colombia
| | - Cristina Domínguez
- Department of Urology, Hospital Universitario Fundación Santa Fe de Bogotá and Universidad de Los Andes School of Medicine, Carrera 7 No. 118-09, Unidad Renal, piso 3, 110111, Bogotá, D.C., Colombia
| | - Carlos Gustavo Trujillo
- Department of Urology, Hospital Universitario Fundación Santa Fe de Bogotá and Universidad de Los Andes School of Medicine, Carrera 7 No. 118-09, Unidad Renal, piso 3, 110111, Bogotá, D.C., Colombia
| | - Juan Ignacio Caicedo
- Department of Urology, Hospital Universitario Fundación Santa Fe de Bogotá and Universidad de Los Andes School of Medicine, Carrera 7 No. 118-09, Unidad Renal, piso 3, 110111, Bogotá, D.C., Colombia
| | - Martín Rondón
- Department of Clinical Epidemiology and Biostatistics, Pontificia Universidad Javeriana, Bogotá, D.C., Colombia
| | - Julián Azuero
- Department of Urology, Hospital Universitario Fundación Santa Fe de Bogotá and Universidad de Los Andes School of Medicine, Carrera 7 No. 118-09, Unidad Renal, piso 3, 110111, Bogotá, D.C., Colombia
| | - Mauricio Plata
- Department of Urology, Hospital Universitario Fundación Santa Fe de Bogotá and Universidad de Los Andes School of Medicine, Carrera 7 No. 118-09, Unidad Renal, piso 3, 110111, Bogotá, D.C., Colombia.
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Dufour S, Wu M. No. 397 - Conservative Care of Urinary Incontinence in Women. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2020; 42:510-522. [PMID: 32303295 DOI: 10.1016/j.jogc.2019.04.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To outline the evidence for conservative care, including both assessment and management options, for urinary incontinence in women. INTENDED USERS Relevant primary care providers and medical specialists including but not limited to physicians, nurses, midwives, and pelvic health physiotherapists. TARGET POPULATION Women (>18 years of age) with urinary incontinence. OPTIONS Assessment options include gathering of a detailed history, physical examination, laboratory analysis, urodynamic evaluation, and cystoscopy. Conservative management options include lifestyle management, pelvic floor muscle training, behavioural management, and mechanical devices. OUTCOMES To provide an evaluation-based summary of current available evidence concerning efficacy of conservative care (assessment and management) strategies for urinary incontinence in women. EVIDENCE The Cochrane Library and Medline (2013-2018) were searched to find articles related to conservative care of urinary incontinence in women (>18 years). Articles were appraised, and the collective evidence was graded. VALIDATION METHODS The evidence obtained was reviewed and evaluated by the Society of Obstetricians and Gynaecologists of Canada (SOGC) Urogynecology Committee under the leadership of the principal authors. The quality of evidence was rated using the criteria described in the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology framework. BENEFITS, HARMS, AND COSTS Evidence for the efficacy of conservative care (assessment and management) options for women with urinary incontinence is strong. Furthermore, these options carry minimal or no harm and confer an established cost benefit. GUIDELINE UPDATE This SOGC Clinical Practice Guideline will be automatically reviewed 5 years after publication. SUMMARY STATEMENTS RECOMMENDATIONS.
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Comparison of Effectiveness between Tension-Free Vaginal Tape (TVT) and Trans-Obturator Tape (TOT) in Patients with Stress Urinary Incontinence and Intrinsic Sphincter Deficiency. PLoS One 2016; 11:e0156306. [PMID: 27228092 PMCID: PMC4882043 DOI: 10.1371/journal.pone.0156306] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Accepted: 05/12/2016] [Indexed: 12/02/2022] Open
Abstract
Background The aim of this study was to compare the two types of mid-urethral slings for stress urinary incontinence (SUI) with intrinsic sphincter deficiency (ISD). Methods This retrospective study included patients who underwent tension-free vaginal tape (TVT) procedure or transobturator tape (TOT) procedure by a single surgeon for SUI with ISD, defined as Valsalva leak point pressure (VLPP) < 60 cmH2O in a urodynamic study. Cases of neurogenic bladder, previous SUI surgery, and concomitant cystocele repair were excluded. The primary outcome was treatment success at 12 months, defined by self-reported absence of symptoms, no leakage episodes recorded, and no retreatment. Results Among the 157 women who were included in the final analysis, 105 patients received TVT and 52 patients received TOT. Age, underlying diseases, Stamey grade, cystocele grade, and presence of urge incontinence were not significantly different between the two groups. Urodynamic parameters including maximal urethral closing pressure, detrusor overactivity, VLPP, urethral hypermobility (Q-tip ≥ 30°), were also comparable between the two groups. Success rate was significantly higher in the TVT group than in the TOT group (95.2% vs. 82.7%, p = 0.009). On multivariate analysis, only TOT surgery (OR = 3.922, 95%CI = 1.223–12.582, p = 0.022) was a risk factor for failure following surgical treatment. Conclusion TVT is more effective than TOT in treatment of female SUI with ISD.
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Yun JH, Kim JH, Park S, Lee C. Changes in the Q-tip angle in relation to the patient position and bladder filling. BMC Urol 2015; 15:101. [PMID: 26446765 PMCID: PMC4597398 DOI: 10.1186/s12894-015-0096-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Accepted: 09/28/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND It is hypothesized that patient position, supine or recline, and bladder filling status, empty or full, could change the Q-tip test result. This study evaluated the effect of the patient position and bladder filling status on the Q-tip angle for urethral hypermobility (UH). METHODS There was a measurement of the Q-tip angle in the supine position and at a 45° angle in a reclining position during bladder emptying; and then the measurements were repeated while filling the bladder. We defined urethral hypermobility as the urethral angle straining or coughing minus that at rest ≥ 30°. RESULTS All 63 female patients (mean age: 61.6 years, range: 36-81) who complained of urinary incontinence were assessed using the Q-tip angle test. The pelvic organ prolapse quantification stages of all patients were ≤ stage 1. The mean Q-tip angle with an empty bladder was 14.1 ± 9.1° in the supine position and 16.4 ± 11.1° in the reclining position (p = 0.001). Then mean Q-tip angle during the filling bladder state was 15.4 ± 9.7° in the supine position and 15.9 ± 11.0° in the reclining position (p = 0.771). The UH rate during the bladder emptying state was 11.1 % (7/63) in the supine position and 19.1 % (12/63) in the reclining position. The UH rate during the bladder filling state was 15.0 % (9/60) in the supine position and 15.3 % (9/59) in the 45° reclining position. The odds ratio (OR) was 7.03 in the reclining position for a positive Q-tip angle. The positive rate was higher in the 45° reclining position during bladder emptying than that in the other position during bladder filling. CONCLUSION The outcome of the Q-tip angle and the rate of UH changed in relation to patient position. The reclining position during bladder emptying increased the Q-tip angle, thereby resulting in a positive UH.
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Affiliation(s)
- Jong-hyun Yun
- Department of Urology, Soonchunhyang University Gumi Hospital, Soonchunhyang University School of Medicine, Gumi, South Korea.
| | - Jae Heon Kim
- Department of Urology, Soonchunhyang University Hospital, Soonchunhyang University School of Medicine, Seoul, South Korea.
| | - Suyeon Park
- Department of Biostatistics, Soonchunhyang University Hospital, Seoul, South Korea.
| | - Changho Lee
- Department of Urology, Soonchunhyang University Cheonan Hospital, Soonchunhyang University School of Medicine, 31 Soonchunhyang 6 gil, Dongnam-Gu, Cheonan, Chungcheongnam-do, 330-721, South Korea.
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