Vaginal Swab Test Compared With the Urethral Q-tip Test for Urethral Mobility Measurement

Abstract

Objective To assess whether a vaginal cotton-tipped swab is equivalent to the standard Q-tip test regarding urethral mobility. Secondarily, to examine whether both tests agree in hypermobility diagnosis, discomfort level, and patients' preference. Methods In this randomized cross-over trial, women with stress urinary incontinence without prolapse beyond the hymen were randomized to undergo either a vaginal or urethral mobility test first followed by the alternate approach. The primary outcome was the difference in rotation angle, from resting to maximum strain, between tests. The equivalence margin was ±10°. The secondary outcome was agreement in hypermobility diagnosis using two definitions, #1 maximum straining angle of ≥30° from the horizontal plane, #2 rotation angle ≥30°. Discomfort was assessed using 0-10 visual analog scale. Using 90% power assuming a standard deviation of 20°, 36 and 139 patients were needed for 10° and 5° equivalence margins, respectively. Results From January 2014 to March 2015, 140 women were randomized. The mean difference between the two tests was 5.1° (95% confidence interval 3.2-6.9°), meeting the predefined equivalence criteria. In the hypermobility diagnosis, the urethral and vaginal tests had no disagreement using the definition #1 (p=0.23) whereas the two tests disagreed using definition #2 (p=0.03). The urethral approach had a higher discomfort level (p<0.001). The majority preferred the vaginal test (68% preferred vaginal, 32% no preference). Conclusion The vaginal swab test is equivalent to the standard Q-tip test in measuring urethral mobility with less discomfort and is preferred by patients.

Urinary incontinence in women

“…The relationship between urethral mobility and stress urinary incontinence has been assessed using a range of techniques, including the POP-Q point Aa descent 69 , urethral Q-tip 70 , vaginal cotton swab 71 , visual evaluation 72 , ultrasonography 72 and lateral chain urethrocystography 73 . However, none of these is recommended and there is no consensus definition for clinically relevant urethral hypermobility.…”

The role of transperineal ultrasound in the evaluation of stress urinary incontinence cases

“…Meyer et al suggested Valsalva with a cotton swab inserted into the vagina as an alternative to the Q-tip test. The comparison of the VAS scores showed that the patients found the vaginal stick method to be less uncomfortable (27). In clinics where ultrasonography is part of the examination, urethral hypermobility can be easily observed and measured with the change in α angle with Valsalva (R α) instead of the rather uncomfortable Q-tip test.…”

Clinical and Urodynamic Predictors of the Q-Tip Test in Women With Lower Urinary Tract Symptoms

“…Because urethral discomfort can occur during Q-tip testing, some authors have tried to substitute it with other surrogates [21][22][23][24]. Meyer et al [21] used a vaginal swab test to predict urethral hypermobility; however, 11 of 80 results (13.8%) were found to be false negatives.…”

“…Because urethral discomfort can occur during Q-tip testing, some authors have tried to substitute it with other surrogates [21][22][23][24]. Meyer et al [21] used a vaginal swab test to predict urethral hypermobility; however, 11 of 80 results (13.8%) were found to be false negatives. Robinson et al [22] used a visual urethral mobility exam to predict urethral hypermobility; however, the visual urethral mobility exam only contains binomial data (i.e., the presence or absence of urethral hypermobility), not continuous data.…”