Role of the Q-tip test in evaluating stress urinary incontinence.

The Q-tip test was applied on 105 patients. Fifty-one had stress urinary incontinency (SUI), 28 had bladder instability by clinical and urodynamic criteria, and 36 had mild or moderate pelvic relaxation without urinary pathology. More than 90% of the patients with SUI and no previous surgery had a positive Q-tip test, with 90% test sensitivity in this group. More than one-third of the patients with bladder instability and almost one-half of the patients with pelvic relaxation and no urinary incontinence had a positive Q-tip test, for low test specificity. The Q-tip test is a simple clinical tool for diagnosing pelvic relaxation, which at times leads to SUI. Almost all patients with primary SUI have pelvic relaxation. The Q-tip test alone does not stand as a diagnostic test. When it is positive, the diagnosis of genuine stress incontinence is possible although not absolute. A negative test should cause one to question the diagnosis of genuine stress incontinence, and sophisticated and more expensive tests should be ordered before establishing a final diagnosis.