Q-tip test: a study of continent and incontinent women

Urethral axis position and mobility, as determined by the "Q-tip test," were measured in subjectively continent women (N = 26), women with genuine stress incontinence (N = 28), and women with other types of urinary incontinence and voiding dysfunction (N = 20). Diagnostic urodynamic evaluation in symptomatic women included standard history, physical examination, urine culture, Q-tip test, uroflowmetry, standing "stress test," resting and stress urethral pressure profiles, and subtracted medium-fill water cystometry with provocation. Multiple regression analysis was used to determine the existence of significant clinical predictors of the dependent variables (stress angle, urethral mobility). These factors were used as covariates to identify differences between the adjusted group means. The results indicate a wide range of values for each Q-tip test measurement in all groups. Age, parity, resting Q-tip angle, and the presence of anterior vaginal relaxation were associated with maximum stress Q-tip measurement. Significant differences in maximum stress Q-tip angle and urethral mobility were noted only between the continent controls and women with genuine stress incontinence. No differences were found between the two incontinent study groups. We conclude that urethral position and mobility as measured by the Q-tip test are related to defects in anterior vaginal support, but not to specific urologic diagnosis.