The « instruments » necessary to perform PP test are a sheet of paper and a pencil (20 cm of length) with a horizontal section of about 0.5 cm diameter.

PP test comprises 3 items.

Item 1 is tested in both women and men: the pencil is vertically placed on a table in front of the patient. The patient must be able to take the pencil with a bi-digital pincer (two fingers of the same hand usually index and thumb), to upturn the pencil and then gently introduce this pencil without collision within the ear canal on the same side. This item tests the possibility to clasp the catheter, correctly orient the catheter and reach a precise target (the meatus) without an important lack of coordination or tremor.

Item 2 M is tested in men: the pencil vertically placed on the table, can be taken by the fingers and palm of the non dominant hand and vertically kept airborne. This item tests the ability for the male patient to clasp the penis vertically in order to locate the urethral meatus and insert the catheter in.

Item 2 Fa is tested in women: in a sitting position, the patient with her non dominant hand must be able to keep the pencil in a horizontal position between the thighs along their proximal thirds. This item tests the voluntary abduction of the thighs (at least 45°) which is necessary to introduce the catheter in the urethra.

Item 2 Fb is also tested in women: fist placed on the table, the patient must be able to spread thumb and index finger in order to install the pencil, with the dominant hand, in a horizontal position on these two fingers without falling down. This item tests the ability for the female patient to ***spread (push aside) labia majora and minora in order to introduce the catheter in the meatus.

Item 2 Fc is tested in women: in a sitting position, the woman must be able to deposit and pick up the pencil between her thighs, on a horizontal chair. This item tests the accessibility to the perineal area without articular limitations (hip abduction limitation, spine flexion limitation, thick abdominal wall in obese female patients …).

Item 3 is tested in men and women: a sheet of paper is placed on the table in front of the patient in a sitting position. The following orders are given:  « fold the paper in two; tear up the piece of paper into two parts; then give me one of the two parts; fold the second part of this paper in four and then put it down between your thighs on your chair ». This item tests not only the ability to handle and open the packing, but also the cognitive strategies required for the accomplishment of the entire CISC manoeuvres: memory, attention, motor programming and coordination, organization praxias, and frontal resources. 

Each item of the PP test is quantified and simply graded as « impossible » (0), « incomplete » (1), « full but difficult » (3) and « possible and easy » (5) (table 2) with a maximal score of 15.