Correlation of Q-tip values and point Aa in stress-incontinent women

Halina M. Zyczynski*, L. Keith Lloyd, Kimberly Kenton, Shawn Menefee, Muriel Boreham, Anne M. Stoddard

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

15 Scopus citations


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°) 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° (30-130°). 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° and 64° (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° (P<.001). Age and prior anterior vaginal or incontinence surgery had no significant effect on the correlation (P=.08 and P=.64, respectively). CONCLUSION: 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.

Original languageEnglish (US)
Pages (from-to)39-43
Number of pages5
JournalObstetrics and gynecology
Issue number1
StatePublished - Jul 2007

ASJC Scopus subject areas

  • Obstetrics and Gynecology


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