Outcome of the bladder cooling test in children with nonneurogenic bladder problems

Area of Science:

• Pediatric Urology
• Neuro-urology
• Developmental Pediatrics

Background:

• The bladder cooling test (BCT) assesses a primitive neonatal spinal reflex.
• This reflex is normally suppressed by descending signals in older children.
• The BCT may re-emerge with suprasacral neurological lesions.

Purpose of the Study:

• To evaluate the outcome of the bladder cooling test (BCT) in a large cohort of children with nonneurogenic bladder issues.
• To correlate BCT results with age and bladder dysfunction in pediatric patients.
• To investigate the BCT's utility in identifying delayed maturation of central bladder control.

Main Methods:

• The BCT was performed on 284 children (1 month to 18 years) undergoing cystometry.
• The test involved infusing warm saline followed by cold saline (3-10°C).
• A positive BCT was defined as a detrusor contraction >30 cm H2O evoked by cold but not warm saline.

Main Results:

• In children under 2 years, 87% of BCTs were positive; this decreased to 21% in 2-3 year olds.
• In children over 4 years with idiopathic urge incontinence, over 50% of BCTs were positive in those under 6 years, declining to 0% by age 13.
• Younger children (<4 years) often had a history of pyelonephritis or high-grade vesicoureteral reflux.

Conclusions:

• The transition from positive to negative BCTs around age 2 likely signifies normal neurological maturation of bladder control.
• Positive BCT results in older incontinent children indicate potential delays in the central nervous system's regulation of bladder function.
• The BCT may serve as a valuable tool for assessing neuro-maturation in pediatric bladder dysfunction.