Urethral Mobility Ultrasound: A Comparable Diagnostic Method for Urethral Hypermobility in Indonesian Women with Stress Urinary

Abstract

Urethral hypermobility is the primary mechanism of stress urinary incontinence. In Indonesia, the prevalence of SUI (stress urinary incontinence) is approximately 13% (the other 16% had mixed urinary incontinence). To diagnose urethral hypermobility, the Q-tip test is performed, but it can provoke discomfort. Urethral mobility ultrasonography (UMU) has emerged as a non-invasive, more comfortable alternative, with high accuracy. This study reports the concordance of the evaluations in Indonesian women with SUI, to evaluate the accuracy of UMU compared with the Q-tip test in diagnosing urethral hypermobility among Indonesian women with SUI. A cross-sectional study was conducted at the outpatient clinic of RSUPN Dr Cipto Mangunkusumo and at the Jakarta Urogynecology (JUN) Centre-YPK Mandiri Hospital during the January – December 2024 period. Thirty-six SUI women without symptomatic pelvic organ prolapse (POP) completed the study. Each subject underwent a Q-tip test and ultrasonographic evaluation of urethral mobility. Ultrasonographic assessment of urethral mobility demonstrated high sensitivity (92.6%) but low specificity (33.3%) compared to the Q-tip test. The positive predictive value (PPV) of UMU was 80.6%, while the negative predictive value (NPV) was 60%. The concordance value was 77.8%. 16.67% of patients reported discomfort and pain during the Q-tip test and required medication to manage their symptoms. In those women, the Qtip test was negative but may reflect bias/false negatives, which can affect ultrasound specificity. With 80.6% PPV, 60% NPV, and 77.8% concordance, UMU may serve as a practical alternative to the Q-tip test in daily clinical practice.