5- Assessment of Urethral Mobility
Anti-incontinence surgery is more successful in women with urethral mobility, defined as a 30 degree or greater displacement from the horizontal when the patient is in a supine lithotomy position and straining. The presence of urethral mobility indicates uncomplicated SUI. Lack of ureth-ral mobility is associated with a 1.9-fold increase in the failure rate of midurethral sling treatment of SUI (13). The cotton swab test has been the traditional assessment of urethral mobility (14), but other methods of evaluating urethral mobility include measurement of point Aa of the POP Quantification system, visualization, palpation, and ultrasonography (15–17). Patients who lack urethral mobility may be better candidates for urethral bulking agents rather than sling or retropubic anti-incontinence procedures.