2313 THE ICE WATER TEST IN IDIOPATHIC DETRUSOR OVERACTIVITY

Abstract

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Urodynamic Testing1 Apr 20122313 THE ICE WATER TEST IN IDIOPATHIC DETRUSOR OVERACTIVITY Samih Al-Hayek, David Scholfield, and Paul Abrams Samih Al-HayekSamih Al-Hayek Bristol, United Kingdom More articles by this author , David ScholfieldDavid Scholfield Sandwich, United Kingdom More articles by this author , and Paul AbramsPaul Abrams Bristol, United Kingdom More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.2494AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The ice water test (IWT) was believed to be a lower motor neuron segmental reflex involving C-fibre afferents. The main aim of this study was to evaluate the validity of the IWT in defining sub-group(s) of patients with idiopathic detrusor overactivity (DO). Those subjects would be likely to respond to future drugs that could be designed to target C-fibre afferents. The secondary purpose of the study was to look at the effect of position and filling speed, as provocative manoeuvres, on detecting DO. METHODS Ethical approval was obtained. Adult patients with previous evidence of idiopathic DO were enrolled. The participants were invited for two visits. At each visit the participant underwent 3 or 4 standard cystometries at different speeds and positions. This was follwed by two cycles of warm water test (WWT) used as a negative control and ice (< 4°c) water test (IWT). The test was considered positive when a sustained detrusor contraction was evoked within 3 minutes of ice water infusion. A control group of healthy volunteers were also recruited to make sure the reaction to ice water is not a physiological response. RESULTS High proportion of patients with idiopathic DO had positive IWT (90.5% in males and 76.2% in females). Only 1% of patients had positive WWT. The test had a high overall short (76.9%) and long term (86.5%) reproducibility rate. Only 18.8% of healthy volunteers had a positive IWT. The gender of the participants, whether they were patients or not, and their DO status were the main factors affecting the outcome of the IWT. Age was not a significant factor. There was no clear difference between patients with DO and positive IWT and those with negative IWTs. Two thirds of DO cases would have been missed if female patients had been filled in a supine compared to vertical position, The difference was less marked in males. The speed of filling had no significant effect if patients were filled in the erect position. CONCLUSIONS IWT is not specific to neurogenic DO, not a normal variant and not mediated by mechano-receptors. With the high prevalence of positive IWT and the lack of difference between individuals with positive and negative IWTs, the test can not define sub-group(s) of patients with distinct C-fibres involvement. However, our results give good grounds and justification for the use of anti C-fibre treatment in patients with idiopathic DO. Detrusor overactivity is best demonstrated when filling cystometry is performed in the erect position. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e933 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Samih Al-Hayek Bristol, United Kingdom More articles by this author David Scholfield Sandwich, United Kingdom More articles by this author Paul Abrams Bristol, United Kingdom More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...