The ice-water test--a simple and valuable supplement to routine cystometry

Area of Science:

• Urology
• Neurology
• Diagnostic Medicine

Background:

• Overactive bladder and voiding dysfunction are common conditions.
• Differentiating neurological causes is crucial for effective treatment.
• Current diagnostic methods may not always distinguish between upper and lower motor neuron lesions.

Purpose of the Study:

• To evaluate the diagnostic utility of the ice-water test (IWT) in patients with bladder dysfunction.
• To determine if IWT can differentiate between upper and lower motor neuron lesions.
• To assess IWT's role in the functional classification of overactive bladders.

Main Methods:

• Retrospective analysis of cystometrograms and IWTs in 557 patients.
• Defined positive IWT as expulsion of fluid within 1 minute of ice-water instillation.
• Defined false negative IWT based on detrusor contraction magnitude without fluid escape.

Main Results:

• 97% of complete and 91% of incomplete upper motor neuron lesions showed a positive or false negative IWT.
• 75% of patients with multiple sclerosis, Parkinson's disease, or cerebrovascular accident had a positive IWT.
• All lower motor neuron lesions and pure stress incontinence patients had a negative IWT.

Conclusions:

• The IWT is a sensitive tool for distinguishing upper from lower motor neuron lesions.
• IWT aids in the functional subdivision of overactive bladders.
• A positive IWT in voiding dysfunction suggests an underlying neurological disorder.