Testing reliability of pubourethral ligament hemostat forceps support test for diagnosis of stress incontinence

The pubourethral ligament (PUL) has been proposed as a key structure in maintaining continence during effort. While midurethral slings (MUS) indirectly support this concept, direct clinical demonstration of PUL function remains limited.

To evaluate clinical utility of the midurethral hemostat forceps test as a functional assessment of PUL integrity; to examine the test's relationship with anatomical and ultrasound observations; to present the methodology of urethral ligament plication (ULP) as a surgical approach that further explores the role of PUL support in SUI.

The hemostat forceps test was performed in 34 women presenting with symptoms of stress urinary incontinence (SUI). The forceps mechanically supports the PUL at its retropubic origin during provocation. Findings were interpreted alongside transperineal ultrasound observations and previously reported outcomes of ULP surgery.

As 14 women had an empty bladder, testing was only feasible in 20 women with demonstrable SUI; 19 showed immediate control of leakage with PUL support. These findings were consistent with ultrasound observations demonstrating restoration of urethral support during mechanical stabilization. Testing under live surgery demonstrated SUI control in 3 women when the polyester suture was tied. Published data on ULP indicate comparable short-term outcomes to midurethral slings.

The hemostat (forceps) test provides a simple, clinically applicable method to assess the functional contribution of the PUL in SUI. Together with surgical and imaging observations, these findings support an important functional role for the PUL in continence mechanisms. Larger controlled studies may be required to further validate these observations.