title: The ice-water test in detrusor hyper-reflexia and bladder instability.
abstract: OBJECTIVE
  To determine: (i) the outcome of the ice-water test (IWT) in patients with an overactive detrusor and to define the sensitivity of the test in differentiating bladder instability from detrusor hyper-reflexia: and (ii) to investigate any differences in sensitivity to the IWT with detrusor hyper-reflexia caused by suprapontine and spinal pathologies.
  
  
  METHODS
  Of 130 consecutive patients with urinary symptoms who underwent a urodynamic evaluation and IWT, 80 had detrusor overactivity; of these 60 had detrusor hyper-reflexia and 20 had bladder instability. The patients with detrusor hyper-reflexia were further subdivided into two groups, suprapontine or spinal, based on the site of the neurological lesion.
  
  
  RESULTS
  The overall sensitivity of the test in patients with detrusor hyper-reflexia was 65% and the specificity 85%. In patients with a spinal pathology causing detrusor hyper-reflexia, the test was positive in 70%, while 46% with suprapontine causes of detrusor hyper-reflexia had a positive test.
  
  
  CONCLUSIONS
  Although 65% of the patients with detrusor hyper-reflexia and known neurological disease had a positive IWT, so did 15% of the patients with no neurological disease and bladder instability. Patients with suprapontine pathology had a lower sensitivity than those with infrapontine pathology, but this was not statistically significant. The relatively larger number of false-negative tests in patients with a suprapontine pathology is one reason why the test is insufficiently sensitive to discriminate between detrusor hyper-reflexia and bladder instability.
authors.affiliation: National Hospital for Neurology and Neurosurgery, London.
authors.forename: T
authors.initials: T
authors.lastname: Petersen
authors.forename: V
authors.initials: V
authors.lastname: Chandiramani
authors.forename: C J
authors.initials: CJ
authors.lastname: Fowler
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003080:Cold Temperature; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009119:Muscle Contraction; D012680:Sensitivity and Specificity; D013118:Spinal Cord Diseases / Q000150:complications / Q000175:diagnosis; D001745:Urinary Bladder Diseases / Q000175:diagnosis* / Q000503:physiopathology; D014554:Urination; D014555:Urination Disorders / Q000209:etiology / Q000503:physiopathology; D014563:Urodynamics