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Comparação do Q-tip teste com o ângulo de rotação da uretra medido por ecografia : estudo observacional de uma coorte histórica
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Resumo(s)
A hipermobilidade uretral é avaliada clinicamente através do ângulo do Q-tip teste. Dado ser um teste desconfortável, avaliámos a correlação do mesmo com o ângulo de rotação da uretra, medido através de ecografia transperineal. Avaliámos se a presença de prolapso de órgão pélvico (POP) em qualquer compartimento interfere nessa correlação.
Consultaram-se os registos clínicos de 250 mulheres que iniciaram vigilância em Uroginecologia no CHULN entre fevereiro de 2016 e setembro de 2021. Consideraram-se os critérios de inclusão – ≥ 18 anos; queixas de incontinência urinária (IU) de esforço ou mista; presença ou ausência de POP – e exclusão – cirurgias prévias de correção de IU ou POP anterior; manobra de Valsalva ineficaz; grávidas e puérperas. Foram obtidos o ângulo do Q-tip teste, a classificação do POP-Q e o ângulo de rotação da uretra. Foi feita uma sub-análise nos grupos: (a) mulheres sem POP ou com POP em qualquer compartimento < grau 2; (b) mulheres com POP de qualquer compartimento ≥ grau 2. Aplicou-se o teste do Qui-Quadrado para avaliar se existia correlação entre o Q-tip teste e ângulo de rotação da uretra e a correlação de Spearman para avaliar a força da correlação (com p<0,05).
Verificou-se uma correlação estatisticamente significativa (p=0,001) e fraca (0,209) entre o ângulo obtido no Q-tip teste e o ângulo de rotação da uretra ecográfico. Esta correlação mantém-se significativa (p=0,002), mas fraca (0,248) no subgrupo (a), não se observando significância estatística (p=0,324) no subgrupo (b).
Concluímos que, globalmente, existe uma correlação entre o Q-tip teste e o ângulo de rotação ecográfico apesar de não ser linear (fraca). Nas mulheres do subgrupo (b) não se verificou correlação entre os dois parâmetros, o que levanta questões sobre a interferência do prolapso na rotação da uretra. Este trabalho veio propiciar a base para novos estudos nesta linha de investigação.
Urethral hypermobility is clinically assessed through the angle of the Q-tip test. As it is an uncomfortable test, we evaluated its correlation with the urethral rotation angle, measured by transperineal ultrasound. We evaluated whether the presence of pelvic organ prolapse (POP) in any compartment interferes with this correlation. Clinical records of 250 women who started surveillance in Urogynecology at CHULN between February 2016 and September 2021 were consulted. Inclusion criteria – ≥ 18 years; complaints of stress or mixed urinary incontinence (UI); presence or absence of POP – and exclusion criteria – previous surgeries to correct UI or POP from the anterior compartment; ineffective Valsalva maneuver; pregnant and puerperal women – were considered. Q-tip test angle, POP-Q classification and urethral rotation angle were obtained. A sub-analysis was performed in the groups: (a) women without POP or with POP in any compartment < grade 2; (b) women with POP of any compartment ≥ grade 2. The Chi-Square test was applied to assess whether there was a correlation between the Q-tip test and urethral rotation angle and the Spearman correlation to assess the strength of the correlation (with p<0.05). There was a statistically significant (p=0.001) and weak (0.209) correlation between the angle obtained in the Q-tip test and the urethral rotation angle measured by ultrasound. This correlation remains significant (p=0.002), but weak (0.248) in subgroup (a), with no statistical significance (p=0.324) in subgroup (b). We conclude that, overall, there is a correlation between the Q-tip test and the urethral rotation angle measured by ultrasound, although it is not linear (weak). In women in subgroup (b) there was no correlation between the two parameters, which raises questions about the interference of prolapse in urethral rotation. This work provided the basis for further studies in this line of investigation.
Urethral hypermobility is clinically assessed through the angle of the Q-tip test. As it is an uncomfortable test, we evaluated its correlation with the urethral rotation angle, measured by transperineal ultrasound. We evaluated whether the presence of pelvic organ prolapse (POP) in any compartment interferes with this correlation. Clinical records of 250 women who started surveillance in Urogynecology at CHULN between February 2016 and September 2021 were consulted. Inclusion criteria – ≥ 18 years; complaints of stress or mixed urinary incontinence (UI); presence or absence of POP – and exclusion criteria – previous surgeries to correct UI or POP from the anterior compartment; ineffective Valsalva maneuver; pregnant and puerperal women – were considered. Q-tip test angle, POP-Q classification and urethral rotation angle were obtained. A sub-analysis was performed in the groups: (a) women without POP or with POP in any compartment < grade 2; (b) women with POP of any compartment ≥ grade 2. The Chi-Square test was applied to assess whether there was a correlation between the Q-tip test and urethral rotation angle and the Spearman correlation to assess the strength of the correlation (with p<0.05). There was a statistically significant (p=0.001) and weak (0.209) correlation between the angle obtained in the Q-tip test and the urethral rotation angle measured by ultrasound. This correlation remains significant (p=0.002), but weak (0.248) in subgroup (a), with no statistical significance (p=0.324) in subgroup (b). We conclude that, overall, there is a correlation between the Q-tip test and the urethral rotation angle measured by ultrasound, although it is not linear (weak). In women in subgroup (b) there was no correlation between the two parameters, which raises questions about the interference of prolapse in urethral rotation. This work provided the basis for further studies in this line of investigation.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2022
Palavras-chave
Ângulo de rotação da uretra proximal Ecografia transperineal Hipermobilidade uretral Incontinência urinária de esforço Q-tip teste Ginecologia