Changes in the Q-tip angle in relation to the patient position and bladder filling

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.