[Usefulness of the cotton swab (Q-Tip) test in general practice]

Cotton swabs (Watup or Q-Tip) were transurethrally applied to 50 women with urinary incontinence of different classification and case history to check for pressing-related inclination of the urethra. Testing was supported by inspection of the anterior vaginal wall and urethrocystography. Speculum examination has been found to provide minimum information, primarily after vaginal operations. Watup testing, however, was in better agreement with X-ray findings. Deviating inspection findings were related solely to positive Watup tests, while deviating X-ray findings were obtained with equal frequency in cases of positive and negative Watup tests (with five each being falsely positive and falsely negative). Higher accuracy was obtained in cases in which Watup tests and inspection findings had been identical. In such cases, complementary X-ray procedures for additional assessment of ventral fixation of the urethra were not necessary, if several signs of increased urethral inclination had been clinically detected. On the other hand, insufficient fixation of the urethra to the symphysis must be considered probable by X-ray examination in about 40 per cent of all cases in which no abnormal mobility of the urethra had been suggested by inspection and Watup test. Hence, negative Watup test would not be sufficient for adequate surgical decision-making.