PREOPERATIVE Q-TIP TEST RESULTS AND OUTCOMES OF TENSION-FREE VAGINAL TAPE

Anne Hardart, M.D. and William Kobak, M.D.

   Objective: To determine whether a preoperative negative Q-tip test is associated with an increased failure rate among women undergoing Tension-free Vaginal Tape (TVT) for stress incontinence.

   Materials and Methods: For this retrospective cohort study, the records of 266 consecutive patients who underwent TVT between 11/98 and 4/02 at Los Angeles County University of Southern California Medical Center were reviewed. A positive Q-tip test, defined as a change with Valsalva of more than 30 degrees, was noted preoperatively in 226 patients, and a negative test was noted in eight others. Q-tip data were unavailable in 32 patients. Other preoperative data included age, parity, body mass index, and previous surgery. Outcome (cure, improvement or failure) was determined by subjective report during routine follow up, and was available for 209 in the positive Q-tip group and all eight in the negative Q-tip group. Results were compared using Fisher’s exact test.

   Results: Among the patients with a negative Q-tip test, subjective failure rate was 4/8 (50%), compared to a failure rate of 6/209 (2.9%) in the positive Q-tip group (p=.00015). Among those with at least three months of follow up, the failure rate was 8/8(50%) in the negative Q-tip group and 6/163(3.7%) in the positive Q-tip group (p=.00038). No significant differences were found between the two groups in terms of age, parity, body mass index or history of previous incontinence surgery.

  Conclusions: While overall subjective cure rates are high for Tension-free Vaginal Tape, patients with a preoperative negative Q-tip test are at high risk for failure.

   Key Words: Q-tip test, urethral hypermobility, Tension-free Vaginal Tape.