Measurement of the Q-tip angle before and after tension-free vaginal tape-obturator (TVT-O): preoperative urethral mobility may predict surgical outcome.

ABSTRACT

INTRODUCTION AND HYPOTHESIS: The purpose of this study was to compare the results of the Q-tip test before and after the tension-free vaginal tape-obturator (TVT-O) in women with stress urinary incontinence (SUI) to determine the value of the Q-tip test in predicting the outcome of transobturator tape (TOT). METHODS: Between June 2008 and June 2009, 59 women with SUI who underwent the TVT-O procedure and were followed up for at least 6 months were analyzed. Urethral hypermobility was defined as a maximal straining angle greater than 30° as measured by the Q-tip test. Parameters of evaluation included a comprehensive medical history, physical examination, Q-tip test, stress test, and urodynamic study, which included determination of the Valsalva leak point pressure. Cure was defined as no leakage of urine postoperatively either subjectively or objectively, whereas failure was defined as the objective loss of urine during the stress test. RESULTS: The patients were divided into two groups according to their preoperative Q-tip angle <30° (group 1, n=21) and ≥30° (group 2, n=38). The Q-tip angle decreased significantly in both groups from 25.9 ± 5.98° preoperatively to 18.4 ± 7.23° postoperatively in group 1 (p=0.04) and from 36.6 ± 6.75° preoperatively to 24.1 ± 5.48° postoperatively in group 2 (p=0.03). The difference was obviously pronounced in group 2. The incontinence cure rate was significantly higher in group 2 (97.4 %) than in group 1 (85.7 %; p=0.04). CONCLUSIONS: Our results suggest that mobility of the proximal urethra is associated with a high rate of success of the TVT-O procedure.