Ice Water Test Research Articles

764 Ice water test in patients with neurogenic lower urinary tract dysfunction: Before or after urodynamics?

764 Ice water test in patients with neurogenic lower urinary tract dysfunction: Before or after urodynamics?

Involuntary Detrusor Contraction Is a Frequent Finding in Patients with Recurrent Urinary Tract Infections

Objective: To check whether subtle voiding dysfunction is related to recurrent urinary tract infection (rUTI). Methods: 254 consecutive patients with at least four episodes of urinary tract infection (UTI) were studied. At least three repeat urodynamic evaluations with an additional ice water test to maximize the detection of involuntary detrusor contraction (IDC) were used. Stress urinary incontinence cases were used as controls. Nonparametric univariate and multivariate analyses were used for statistics. Results: IDC was detected in 83.6% of patients in the rUTI group and in 31.7% in the control group. IDC was <15 cm H₂O in 54.7% whereas high-amplitude (>50 cm H₂O) IDC was observed in 6.8% in the rUTI group. Female urinary tract obstruction was diagnosed in 16.8% of patients in the rUTI group and in 7.9% in the control group. Residual volume, P_detQ_max and Q_max were not predictive of UTI recurrence. Symptoms were similar in both groups. Conclusions: Patients with rUTI present with covert bladder dysfunctions represented by detrusor overactivity.

150. Somatic pain sensitivity during experimentally-induced inflammation in humans

Background: Enhanced pain sensitivity is a component of sickness behavior in experimental animals. However, data on the effects of systemic immune activation on pain processing in humans are rare thus far. Therefore, the goal of this ongoing study is to analyze time- and dose-dependent effects of experimentally-induced systemic immune activation on somatic pain responses in healthy male volunteers. Methods: Employing a randomized, placebo-controlled between-group design, healthy male subjects receive an i.v. injection of either lipopolysaccharide (LPS groups; 0.4 ng/kg or 0.8 ng/kg) or saline (control group). Pain thresholds are analyzed by using pressure algometry, pinprick stimulation and ice water test and are evaluated with visual analogue scales before (baseline) and 1, 3 and 6 h post-injection. Blood samples are taken at baseline, and 1, 2, 3, 4, and 6 h after injection to assess plasma levels of proinflammatory cytokines. Results: LPS injection resulted in a systemic, transient inflammatory response, reflected by significant increases in TNF-alpha, interleukin-6 plasma levels, and body temperature (all p

Experimental endotoxemia as a model to study somatic pain sensitivity in humans

An enhanced pain sensitivity is one component of sickness behavior in experimental animals. However, data assessing effects of systemic immune activation on pain in humans are scarce thus far. Hence, this study aims to analyze time- and dose-dependent effects of a systemic immune activation on somatic pain responses healthy male volunteers. In this ongoing study, we implemented a randomized, placebo-controlled between-group design. Following baseline, healthy males received an i.v. injection of either lipopolysaccharide (LPS groups; 0.4 ng/kg or 0,8 ng/kg) or saline (control group). Pain thresholds were assessed by using an Algometer, pinprick stimulation and ice water test. Subjective painfulness of the different stimuli was evaluated using visual analogue scales. The pain-stimulation was performed at baseline, 1, 3 and 6 h after injection. Blood samples are collected before and 1, 2, 3, 4, and 6 h after injection to assess changes in proinflammatory cytokines. LPS administration was followed by a systemic, transient inflammatory response, reflected by significant increases in TNF-alpha, interleukin-6 plasma levels, and body temperature (all p These observations support the relevance of systemic inflammation in the pathophysiology of human somatic pain sensitivity. Our data suggest differential effects of systemic immune activation on different pain models with most pronounced effects for pressure pain.

The undead: organ harvesting, the ice-water test, beating-heart cadavers--how medicine is blurring the line between life and death

The undead: organ harvesting, the ice-water test, beating-heart cadavers--how medicine is blurring the line between life and death

Influence of ice water test on first desire to void on cystometry: Retrospective study of 165 patients

Influence of ice water test on first desire to void on cystometry: Retrospective study of 165 patients

Thermal-Shock Testing and Fracturing of MLCCs Under Manual-Soldering Conditions

The fracturing and failures of multilayer ceramic capacitors (MLCCs) after manual soldering onto printed wiring boards are often associated with a soldering-induced thermal shock that results in substantial mechanical stresses in the parts. Recommendations and guidelines for safe soldering conditions are well developed and documented; however, there is a lack of adequate testing for the selection of MLCCs that are robust enough to sustain stresses related to manual soldering. In this paper, various lots of X7R-type material MLCCs with different size have been subjected to three types of thermal-shock testing: terminal solder-dip test, ice-water test, and liquid-nitrogen drop test. The electrical characteristics of the parts were measured through various test conditions to determine critical temperatures that resulted in fracturing and electrical failures. Optical examinations and cross-sectional analysis were used to confirm the presence of cracks. The mechanisms of fracturing, factors affecting crack formation, and the effectiveness of different thermal-shock methods are discussed.

2313 THE ICE WATER TEST IN IDIOPATHIC DETRUSOR OVERACTIVITY

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 ...

UP-03.214 The Place of the Ice Water Test During the Urodynamic Evaluation

UP-03.214 The Place of the Ice Water Test During the Urodynamic Evaluation

Factor analysis of responses to thermal, electrical, and mechanical painful stimuli supports the importance of multi-modal pain assessment

During the last decade, a multi-modal approach has been established in human experimental pain research for assessing pain thresholds and responses to various experimental pain modalities. Studies have concluded that differences in responses to pain stimuli are mainly related to variation between individuals rather than variation in response to different stimulus modalities. In a factor analysis of 272 consecutive volunteers (137 men and 135 women) who underwent tests with different experimental pain modalities, it was determined whether responses to different pain modalities represent distinct individual uncorrelated dimensions of pain perception. Volunteers underwent single painful electrical stimulation, repeated painful electrical stimulation (temporal summation), test for reflex receptive field, pressure pain stimulation, heat pain stimulation, cold pain stimulation, and a cold pressor test (ice water test). Five distinct factors were found representing responses to 5 distinct experimental pain modalities: pressure, heat, cold, electrical stimulation, and reflex-receptive fields. Each of the factors explained approximately 8% to 35% of the observed variance, and the 5 factors cumulatively explained 94% of the variance. The correlation between the 5 factors was near null (median ρ = 0.00, range −0.03 to 0.05), with 95% confidence intervals for pairwise correlations between 2 factors excluding any relevant correlation. Results were almost similar for analyses stratified according to gender and age. Responses to different experimental pain modalities represent different specific dimensions and should be assessed in combination in future pharmacological and clinical studies to represent the complexity of nociception and pain experience. Responses to different experimental pain modalities represent different specific dimensions, supporting multimodal pain assessment for clinical and research purposes.

Multifactorial causes of irritating bladder symptoms in patients with sjögren's syndrome

AIMS Patients with Sjögren's syndrome (SS) are reported to have an increased severity of irritating bladder symptoms, including urinary frequency and urgency. The mechanism remains unclear. The aim of this study is to elucidate the possible etiologies underlying this problem. Data from 23 female patients with SS (15 primary and 8 secondary) who were treated in the urology clinic for chronic, irritating bladder symptoms were studied. Evaluation of each subject is composed of lower urinary tract symptoms (LUTS), bladder diary entries, and urodynamic studies, which also included an ice water test (IWT) to detect the presence of a C-fiber mediated micturition pathway. Interstitial cystitis (IC) was diagnosed with post-hydrodilatation cystoscopic findings of glomerulations and a KCl test. These patients complained predominantly of overactive bladder symptoms (OAB), including frequency (n=20, 87%), nocturia (n=16, 66%), and urgency (n=12, 52%). Based on the aforementioned evaluations, four patients (17%) had polyuria with normal bladder function, nine patients (39%) had detrusor overactivity (DO), seven patients (32%) had bladder hypersensitivity (including two patients (9%) diagnosed with IC), and three patients (13%) had negative findings. Ice water instillation neither elicited novel involuntary contractions, both in those with or without DO. Five of the six patients (83%) with DO versus one of the four patients (25%) without DO responded to antimuscarinic therapy. Various factors contribute to the irritating bladder symptoms in patients with SS, with DO being predominant. The LUTS developed in patients with SS are not due to any specific single etiology and that each patient must be individually carefully evaluated.

Cold perception of the bladder during ice water test. Study on 120 patients

ObjectiveIf 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. Patient and methodsHundred 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. ResultsPatients 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%. ConclusionPatients 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.

Vestibular myogenic potentials of athletes for the Deaf Olympic Games with congenital profound hearing loss

Conclusions: Our study revealed that VEMPs in responses to clicks and 500 Hz STB were abnormal in 25% of athletes with congenital profound sensorineural hearing loss for the Deaf Olympic Games. These results confirm that a part of deaf athletes with congenital vestibular failure is well compensated for higher level sport activities. Objectives: The aim of this study was to investigate the appearance rate of VEMP, vestibular failure and its compensation in Japanese deaf athletes by the VEMP test, caloric test and balance test. Methods: Sixteen subjects among the Deaf Olympic Games athletes of Japan volunteered to participate in this study. All the subjects have congenital profound sensorineural hearing loss. Results: In the VEMP test, 24 ears (75%) showed normal click-evoked responses, 5 ears (16%) showed decreased click-evoked responses, 3 ears (9%) showed no click-evoked responses, 28 ears (87.5%) showed normal 500 Hz short tone burst (STB)-evoked responses and 4 ears (12.5%) showed decreased responses. In the ice-water caloric test, 11 subjects (69%) showed normal responses bilaterally, 3 subjects showed bilateral responses with asymmetrical responses and 2 subjects (12%) showed no response bilaterally. All the subjects showed normal balance test results.

The effect of intravesical oxybutynin on the ice water test and on electrical perception thresholds in patients with neurogenic detrusor overactivity

The C-fiber-mediated bladder-cooling reflex and the determination of the current perception thresholds (CPTs) permit to investigate afferent LUT pathways. They have both been proposed to detect and differentiate neurologic bladder dysfunction. This study evaluates, prospectively, the effect of oxybutynin, an antimuscarinic with direct antispasmodic effect on smooth muscle, on repeated ice water test (IWT) and CPTs in patients with a known incomplete neurogenic bladder. Patients with a known incomplete lesion of the bladder innervation, detrusor overactivity during cystometric bladder filling and a continuous positive response to repeated IWT were included. After the initial tests, 30 mg intravesical oxybutynin (1 mg/ml) was instilled and left in the bladder for 15 min. Afterwards CPTs and IWT were re-assessed. After the drug application, the bladder-cooling reflex could not be initiated, even after three instillations, in 16/17 patients. The bladder CPT increased from 29.7 +/- 11.3 to 39.1 +/- 15.7 mA after oxybutynin (P = 0.001). No difference was found in CPT of the left forearm (P = 0.208). Intravesical oxybutynin blocks the bladder-cooling reflex and increases but does not block CPT sensation in the bladder in most patients with incomplete neurogenic lesion and detrusor overactivity. These results help explain the clinical effect of intravesical oxybutynin in neurogenic patients. They also indicate that a pharmacological local influence on C-fiber-related activity can give different clinical effects.

The TRPV4 Cation Channel Mediates Stretch-evoked Ca2+ Influx and ATP Release in Primary Urothelial Cell Cultures

Transient receptor potential channels have recently been implicated in physiological functions in a urogenital system. In this study, we investigated the role of transient receptor potential vanilloid 4 (TRPV4) channels in a stretch sensing mechanism in mouse primary urothelial cell cultures. The selective TRPV4 agonist, 4alpha-phorbol 12,13-didecanoate (4alpha-PDD) evoked Ca(2+) influx in wild-type (WT) urothelial cells, but not in TRPV4-deficient (TRPV4KO) cells. We established a cell-stretch system to investigate stretch-evoked changes in intracellular Ca(2+) concentration and ATP release. Stretch stimulation evoked intracellular Ca(2+) increases in a stretch speed- and distance-dependent manner in WT and TRPV4KO cells. In TRPV4KO urothelial cells, however, the intracellular Ca(2+) increase in response to stretch stimulation was significantly attenuated compared with that in WT cells. Stretch-evoked Ca(2+) increases in WT urothelium were partially reduced in the presence of ruthenium red, a broad TRP channel blocker, whereas that in TRPV4KO cells did not show such reduction. Potent ATP release occurred following stretch stimulation or 4alpha-PDD administration in WT urothelial cells, which was dramatically suppressed in TRPV4KO cells. Stretch-dependent ATP release was almost completely eliminated in the presence of ruthenium red or in the absence of extracellular Ca(2+). These results suggest that TRPV4 senses distension of the bladder urothelium, which is converted to an ATP signal in the micturition reflex pathway during urine storage.

Stimulation of skin menthol receptors stimulates detrusor activity in conscious rats

The Transient Receptor Potential Melastatin (TRPM)8 channel, activated by menthol and cool temperatures, has been proposed to be a cool receptor involved in mediation of the bladder response in the diagnostic ice water test. We examined the expression of TRPM8 in the rat skin and investigated if stimulation of skin menthol receptors by menthol can induce detrusor activity in conscious rats. Immunofluorescence staining for TRPM8 was performed in samples of the skin from the leg and back of the rats. Continuous cystometry was performed in conscious animals. Voiding interval (VI), micturition volume (MV), and bladder capacity (BC) were evaluated before and after spraying menthol solution to the skin of the leg and back of the rats. Immunohistochemical analysis revealed that TRPM8 was expressed in the investigated tissues. The expression of TRPM8-positive receptors was not significantly different between the leg and back skin. Saline caused no significant change in cystometric parameters. After spraying menthol solution (50% and 99% to the skin of the leg, and 99% to the back skin), VI, MV, and BC decreased significantly. TRPM8 is expressed in rat skin. Spraying menthol solution onto the skin-induced detrusor activity, an effect we suggest is mediated by stimulation of TRPM8 receptors.

Ice Water Testing Reveals Hypersensitivity in Adult Rats That Experienced Neonatal Bladder Inflammation: Implications for Painful Bladder Syndrome/Interstitial Cystitis

We determined whether clinical observations of hypersensitivity to ice water testing, that is infusion of ice-cold saline into the bladder, in patients with painful bladder syndrome/interstitial cystitis have a parallel in a rat model of bladder hypersensitivity produced by neonatal inflammation. Rat pups were anesthetized as neonates (postnatal days 14 to 16). In some pups the bladder was inflamed by intravesical zymosan treatment. As adults, the rats were re-anesthetized and tested for abdominal muscle contractions to ice water testing, measured on electromyogram. Various neonatally treated groups of rats underwent bladder re-inflammation/no re-inflammation and/or bladder distention before ice water testing. Other control rats were treated only in adulthood. Rats that underwent bladder inflammation as neonates manifested bladder hypersensitivity in adulthood, as indexed by significantly greater mean electromyogram responses during ice water testing. This bladder hypersensitivity did not require adult re-inflammation to manifest. Hypersensitivity was also observed with or without prior bladder distention, although the magnitude of electromyogram responses during ice water testing significantly correlated with the magnitude of electromyogram responses to bladder distention. Neonatally induced effects were not significantly related to estrous cycle phase. Exposure to menthol did not significantly enhance the overall magnitude of the electromyogram response to ice water testing in neonatally treated rats. Current results parallel those in a recent study showing that most patients with painful bladder syndrome/interstitial cystitis experience pain when undergoing ice water testing after previous urodynamic testing. These findings suggest that this animal model may be useful for understanding the etiology of and treatment for painful bladder syndrome/interstitial cystitis.

The ice-water caloric test

Conclusions: Three possible results are commonly seen after ice-water caloric irrigation and to correctly interpret them the function of the corresponding vestibular receptor and of normal endolymphatic flow must be taken into account. Bedside vestibular examination helps to interpret discrepant findings. Objective: To review the findings obtained with the ice-water caloric test in patients with dizziness and to compare the results with those of the bedside test. Patients and methods: The study was undertaken in a university hospital, tertiary medical center. The indications to perform the ice-water caloric test were: 1) unilateral canal weakness >90%; 2) a maximum slow phase velocity of nystagmus after hot (44°C) and cold (30°C) caloric stimulation in either ear of <9° s–1; or 3) in both ears <15° s–1. After irrigating the ear with ice water, nystagmus was recorded in the face-up and face-down positions. The result of the test was classified as a response (nystagmus beats away from the irrigated ear in the supine position and changes when in prone), a gravity-independent response (nystagmus does not change in direction in the prone position) or no response. The spontaneous and post head-shaking nystagmus, as well as the results of the head-impulse test, were also analyzed. When indicated, a rotatory chair test was performed. Results: In the 71 patients that displayed unilateral hypofunction, the ice-water test produced a normal response in 24, a gravity-independent response in 31, and no response in 14. In two of these patients a vertical gravity-independent nystagmus response was observed. Bilateral hypofunction was found in 12 patients and the results in the head-impulse test were in agreement with the results in the ice-water test.

Repeated Ice Water Tests and Electrical Perception Threshold Determination to Detect a Neurologic Cause of Detrusor Overactivity

To explore the added value of a repeated ice water test (IWT) and electrical perception threshold (EPT) measurement in the search for a neurologic cause of idiopathic detrusor overactivity (DOA). The IWT, if originally negative, was repeated up to three times, and EPT measurements were done in 63 patients with neurologic DOA, 117 patients with idiopathic DOA without outflow obstruction, and 30 women with stress urinary incontinence without DOA. Although the IWT was positive in 46% of the neurologic patients if used once, this percentage became 86% when the IWT was repeated. In nonneurologic patients, one IWT was positive in only 7% and when repeated, the positive test rate increased to 24%. IWT, even repeated, remained negative in the women with stress urinary incontinence. The EPTs were not significantly different between the neurologic and nonneurologic patients with a positive IWT, except after the third instillation. In those with negative IWTs, the EPTs were significantly different between the neurologic and nonneurologic patients, independent of the number of IWTs done. If the EPTs were compared within each group between those with positive and negative IWTs, the difference was not significant at the first IWT. However, the difference became statistically significant after two IWTs for the nonneurologic group and after three IWTs for both groups. Our results have shown that repeating the IWT will increase its positivity. Combining the IWT and EPT will reinforce the results of both tests and can indicate more clearly the possibility of an unsuspected neurologic pathologic finding in patients with idiopathic DOA.

Can the ice-water test predict the outcome of intradetrusor injections of botulinum toxin in patients with neurogenic bladder dysfunction?

The aim of this project was to evaluate the ice-water test as a predictor of the response to intradetrusor botulinum toxin injection in patients with neurogenic detrusor overactivity. We retrospectively evaluated the urodynamic parameters in 22 patients with neurogenic bladder dysfunction and positive ice-water test. Maximum cystometric capacity (MCC), reflex volume (RV), maximum detrusor pressure during voiding (MVP) and bladder compliance (BC) were compared before and after intradetrusor injection of 300 units botulinum toxin and calculated as a quotient. The ice-water test was performed before the injection, and the maximum pressure rise and the time to maximum pressure were measured. Furthermore, the ratio between maximum pressure and time to reach maximum pressure was calculated as the velocity of pressure rise. Correlations between the ice-water test criteria and the quotients of the cystometric data before and after injection were determined by the Spearmen's Rho coefficient. The increase in MCC and RV after botulinum toxin A injection showed a small positive, but insignificant correlation of 0.25 and 0.2 to the velocity of pressure rise of the ice-water test. A small negative, but insignificant correlation was found in change of BC and MVP with -0.17 and -0.2, respectively. Based on our population the ice-water test cannot predict the efficacy of intradetrusor botulinum toxin injections in patients with neurogenic detrusor overactivity.