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The ice‐water test in detrusor hyper‐reflexia and bladder instability
Author(s) -
Petersen T.,
Chandiramani V.,
Fowler C.J.
Publication year - 1997
Publication title -
british journal of urology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 0007-1331
DOI - 10.1046/j.1464-410x.1997.03203.x
Subject(s) - detrusor instability , medicine , urinary bladder , detrusor sphincter dyssynergia , urinary system , urology , central nervous system disease , neurological disorder
Objectives To determine: (i) the outcome of the ice‐water test (IWT) in patients with an overactive detrusor and to define the sensitivity of the test in differentiating bladder instability from detrusor hyper‐reflexia; and (ii) to investigate any differences in sensitivity to the IWT with detrusor hyper‐reflexia caused by suprapontine and spinal pathologies. Patients and methods Of 130 consecutive patients with urinary symptoms who underwent a urodynamic evaluation and IWT, 80 had detrusor overactivity; of these 60 had detrusor hyper‐reflexia and 20 had bladder instability. The patients with detrusor hyper‐reflexia were further subdivided into two groups, suprapontine or spinal, based on the site of the neurological lesion. Results The overall sensitivity of the test in patients with detrusor hyper‐reflexia was 65% and the specificity 85%. In patients with a spinal pathology causing detrusor hyper‐reflexia, the test was positive in 70%, while 46% with suprapontine causes of detrusor hyper‐reflexia had a positive test. Conclusions Although 65% of the patients with detrusor hyper‐reflexia and known neurological disease had a positive IWT, so did 15% of the patients with no neurological disease and bladder instability. Patients with suprapontine pathology had a lower sensitivity than those with infrapontine pathology, but this was not statistically significant. The relatively larger number of false‐negative tests in patients with a suprapontine pathology is one reason why the test is insufficiently sensitive to discriminate between detrusor hyper‐reflexia and bladder instability.