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Related Experiment Videos

Bladder cooling reflex in patients with multiple sclerosis.

S S Ismael1, T Epstein, B Bayle

  • 1Department of Neurologic Rehabilitation and Perineal Explorations, Rothschild Hospital, Paris, Cedex, France.

The Journal of Urology
|September 19, 2000
PubMed
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Intravesical ice water instillation effectively identifies involuntary detrusor contractions in multiple sclerosis patients, suggesting a spinal mechanism for overactive bladder. This diagnostic method aids in understanding bladder dysfunction in neurological conditions.

Area of Science:

  • Urology
  • Neurology
  • Physiology

Background:

  • Multiple sclerosis (MS) can cause urinary disorders, including overactive bladder (OAB).
  • Diagnosing the specific mechanism of OAB in MS patients is crucial for targeted treatment.
  • Traditional cystometry may not always reveal detrusor overactivity in these patients.

Purpose of the Study:

  • To investigate the efficacy of intravesical ice water instillation in detecting involuntary detrusor contractions (IDCs) in patients with MS and urinary disorders.
  • To differentiate between spinal and cerebral mechanisms of OAB in MS patients.

Main Methods:

  • A study involving 39 patients with MS (10 men, 29 women; mean age 50 years) without a prior diagnosis of OAB.
  • Performed cystometry using saline at 25-30°C and ice water (0-4°C) at a rate of 100 ml/min.

Related Experiment Videos

  • Defined a positive ice water cystometry test by the occurrence of IDCs before 400 ml of filling.

    • Main Results:

    • Ice water cystometry elicited IDCs in 21 patients (54%), which were not detected by warm water cystometry.
    • A positive ice water cystometry test was significantly associated with irritative urinary signs and elevated post-void residual urine volume.
    • The findings suggest the involvement of capsaicin-sensitive C fibers in triggering IDCs.

    Conclusions:

    • Ice water cystometry is a valuable tool for detecting IDCs in MS patients, potentially indicating a spinal lesion.
    • The results suggest that OAB in MS patients may primarily involve spinal mechanisms rather than cerebral ones.
    • This diagnostic approach may help elucidate the pathophysiology of OAB in MS and identify multifocal demyelination.