What is the role of the Marshall test in the evaluation of urinary incontinence?

Updated: Jan 22, 2021
  • Author: Sandip P Vasavada, MD; Chief Editor: Edward David Kim, MD, FACS  more...
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If the cough stress test is positive, a Marshall test (also known as the Marshall-Bonney test) may determine if the urine loss is caused by urethral hypermobility. This test consists of stress testing with support provided for the proximal urethra.

The Marshall test is performed by placing an index finger and the second finger on either side of the bladder neck, to support the proximal urethra. With the bladder relatively full, the patient is instructed to perform Valsalva or cough. The absence of leakage with bladder neck elevation and the presence of leakage without of bladder neck support confirms stress urinary incontinence due to urethral hypermobility.

In addition to examiners’ fingers, a number of other ways to provide elevation and support of the urethrovesical junction for this test have been described, including ring forceps, large cotton-tipped swabs, and specialized instruments. Data do not exist to recommend one method over another definitively.

The Marshall test has been criticized for susceptibility to examiner error. If one is not careful, the supporting fingers may accidentally occlude the urethra (ie, rather than supporting the bladder neck) and cause a false-positive result. A negative result (ie, incontinence persists despite support to the hypermobile urethra) may also be useful, however, in that it might dictate a more aggressive surgical approach, such as performing a sling procedure rather than a Burch retropubic urethropexy.

Nevertheless, the Marshall test is neither sensitive nor specific enough to diagnose stress urinary incontinence by current standards. Thus, this test is no longer widely used.

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