title: Diagnostic accuracy of visual urethral mobility exam versus Q-Tip test: a randomized crossover trial.
abstract: OBJECTIVE
  The objective of the study was to compare the diagnostic accuracy of a visual urethral mobility examination (VUME) with a Q-Tip test in the assessment of urethral hypermobility.
  
  
  METHODS
  Subjects were randomized to a VUME or Q-Tip test first, followed by the alternate assessment. Outcomes included hypermobile, not hypermobile, or indeterminate. Hypermobility was defined as 30° or greater from the horizontal. Pain perception and test preference were assessed.
  
  
  RESULTS
  For the 54 subjects, 61.1% demonstrated hypermobility on VUME vs 72.2% on the Q-Tip test (P = .39). Assessment of hypermobility was correlated between the 2 tools (ρ = 0.47, P = .001). Positive and negative predictive value, sensitivity, and specificity for VUME were 88%, 56%, 78%, and 71%, respectively, with a Q-Tip test as the reference standard. Mean pain score on visual analog scale was 0.72 for VUME and 3.15 for Q-tip test (P < .001). VUME was preferred by 83% of subjects.
  
  
  CONCLUSIONS
  VUME is a diagnostic alternative to the Q-Tip test for the assessment of urethral hypermobility and is preferred by subjects.
authors.affiliation: Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC 27599-7570, USA. blrobins@med.unc.edu
authors.forename: Barbara Lynn
authors.initials: BL
authors.lastname: Robinson
authors.forename: Elizabeth Joanne
authors.initials: EJ
authors.lastname: Geller
authors.forename: Brent Ashley
authors.initials: BA
authors.lastname: Parnell
authors.forename: Andrea Kuntaraf
authors.initials: AK
authors.lastname: Crane
authors.forename: Mary Lee
authors.initials: ML
authors.lastname: Jannelli
authors.forename: Ellen Casper
authors.initials: EC
authors.lastname: Wells
authors.forename: AnnaMarie
authors.initials: A
authors.lastname: Connolly
authors.forename: Catherine Ann
authors.initials: CA
authors.lastname: Matthews
mesh_terms: D000368:Aged; D018592:Cross-Over Studies; D003950:Diagnostic Techniques, Urological / Q000009:adverse effects; D005260:Female; D006801:Humans; D008875:Middle Aged; D010147:Pain Measurement; D057240:Patient Preference / Q000706:statistics & numerical data; D010865:Pilot Projects; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D014521:Urethra / Q000503:physiopathology*; D014550:Urinary Incontinence, Stress / Q000503:physiopathology*