Apical suspension test.

In stress incontinence, urinary leakage can be controlled by support of the anterior vaginal wall by applying pressure directly at the bladder neck (the Marshall test) or applying pressure remotely. In the latter maneuver, a cotton ball, gripped in the jaws of a sponge stick, engages the vaginal vault near the apex and rotates it posteriorly and horizontally. This tenses the anterior vaginal wall thereby controlling stress-induced leakage. The mechanism of action and some surgical implications are discussed.