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The ice-water test in detrusor hyper-reflexia and bladder instability
T Petersen1, V Chandiramani, C J Fowler
1National Hospital for Neurology and Neurosurgery, London.
British Journal of Urology
|February 1, 1997
Summary
The ice-water test (IWT) shows moderate sensitivity for diagnosing detrusor hyper-reflexia, but it often misidentifies bladder instability in patients with neurological conditions.
Area of Science:
- Urology
- Neurology
- Diagnostic Testing
Background:
- Detrusor overactivity is a common urodynamic finding.
- Differentiating bladder instability from detrusor hyper-reflexia is crucial for appropriate management.
- The ice-water test (IWT) is a diagnostic tool used in evaluating bladder dysfunction.
Purpose of the Study:
- To evaluate the outcome of the ice-water test (IWT) in patients with overactive detrusor.
- To determine the sensitivity of the IWT in distinguishing bladder instability from detrusor hyper-reflexia.
- To investigate differences in IWT sensitivity for detrusor hyper-reflexia based on suprapontine versus spinal pathologies.
Main Methods:
- Urodynamic evaluation and IWT performed on 130 patients with urinary symptoms.
- 80 patients diagnosed with detrusor overactivity: 60 with detrusor hyper-reflexia and 20 with bladder instability.
- Detrusor hyper-reflexia patients categorized by suprapontine or spinal neurological lesion site.
Main Results:
- Overall IWT sensitivity for detrusor hyper-reflexia was 65%; specificity was 85%.
- Positive IWT rate was 70% for spinal pathology-induced detrusor hyper-reflexia.
- Positive IWT rate was 46% for suprapontine pathology-induced detrusor hyper-reflexia.
Conclusions:
- The IWT has limited sensitivity for discriminating between detrusor hyper-reflexia and bladder instability.
- A significant proportion of patients with bladder instability (15%) tested positive on the IWT.
- Lower IWT sensitivity in suprapontine pathologies contributes to diagnostic limitations.