ABSTRACT
Assessment of Urethral Anatomy Physical Examination An examination of the external genitalia and anterior vaginal wall will provide substantial information regarding urethral anatomy. Urethral caruncles, urethral prolapse, and Skene’s gland obstruction or inflammation are easily detected. The presence of urethral scarring or induration may also suggest post-operative or alternative conditions, which could adversely affect urethral function. Vaginal wall thinning or a pale appearance to the urethra implies vaginal atrophy, which can predispose to certain urologic conditions. Lastly, a bulging or purulent expressate is suspicious for urethral diverticulum, and this could predispose to leakage, infection and rarely obstruction. A loss of urethral support can be assessed using a half-speculum, and examining the anterior vaginal wall in the resting and straining state. Urethral hypermobility is usually easily discernable on examination by the classic rotational appearance of the urethra. In most instances, a visual assessment is enough to confirm the presence of urethral hypermobility. In select instances, a Q-Tip test may be used. This test has demonstrated good interobserver reliability ( 7 , 8 ). The Q-tip test is performed by inserting a sterile lubricated Q-tip into the bladder, and gently withdrawing it until resistance is felt insuring proper positioning at urethrovesical junction. The angle of deflection with straining should be measured with goniometer. Urethral hypermobility is defined as maximal straining angle of more than 30° from horizontal (9) or from resting angle. In most cases, this test is unnecessary and may be uncomfortable, so its use should be limited to those cases where it will change the course of treatment.
