Article

If the pathophysiology of bladder cooling reflex (BCR) elicited during
an ice water test (IWT) is well-known (triggered by activation of cold receptors
within the bladder wall supplied by unmyelinated C fiber afferents) and is widely
used for the diagnosis of upper motor neurological lesions, the significance of
having a perception of cold in the bladder (PCB) during IWT has not been properly
defined yet. METHODS: Hundred and twenty patients undergoing IWT were
analyzed and separated into four groups: group 1 (G1): patients with idiopathic
overactive bladder syndrome (OAB); group 2 (G2): patients with functional dysuria
(difficult urination due to bladder-neck obstruction, or congenital large
bladder); group 3 (G3): patients with multiple sclerosis (MS) and group 4 (G4):
patients with cauda equina syndrome (CES). All patients had a cystometry and IWT.
After performing IWT, the patients were asked specific questions regarding the
various sensations experienced during the cystometry and IWT, especially for
detecting the presence or not of a cold sensation when their bladder was filling
up. RESULTS: Patients with idiopathic OAB had more frequently a PCB than patients
with MS (P<0.02). Patients with bladder-neck obstruction were more likely to
retain a PCB than patients with CES (P<0.01). Lack of PCB is more frequent in
patients with neurological diseases (P<0.001), with a sensitivity of 66% and
specificity of 65%. CONCLUSION: Patients without neurological disease have a
heightened PCB during the IWT than patients with neurological diseases. The lack
of PCB may reflect an alteration of the afferent pathways or spinal reflex pathways or central neural pathways.
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Langue : ANGLAIS ; FRANCAIS