Can we use a catheter to do the q-tip test?

OBJECTIVE

To compare two commonly used modifications to the standard Q-tip test for urethral hypermobility: catheter alone and catheter with Q-tip.

METHODS

All women referred for the evaluation of urinary incontinence or pelvic organ prolapse were included in the study. A postvoid residual urine was collected on each patient and the angle of the urethra with the horizontal plane was measured at rest and with Valsalva with the Q-tip, catheter alone, and catheter with Q-tip. The test was considered positive if the angle of excursion was 30 degrees or more.

RESULTS

In this group of 100 consecutive women with urinary incontinence or pelvic organ prolapse, the mean change in the angle was significantly different from the standard Q-tip test (51 degrees) when catheter alone (35 degrees, P<.001) or catheter with Q-tip modifications were used (44 degrees, P<.001). This difference was due to a significant reduction in the resting and Valsalva maneuver angles with the catheter alone, and a significant decrease only in the Valsalva maneuver angle with the catheter with Q-tip method (P<.001). The percentage of positive tests for the standard Q-tip test (92%) was significantly different from the catheter only method (63%, P<.001), and from the catheter with Q-tip technique (83%, P=.021). The "best match" values of 10 degrees for the catheter alone, and 15 degrees for the catheter with Q-tip methods produce the best equivalent results at this time.

CONCLUSION

The use of a catheter, instead of a Q-tip, in the evaluation of urethral hypermobility resulted in reduced angles of excursion from resting to Valsalva maneuver.

LEVEL OF EVIDENCE: III.