Outcome of the bladder cooling test in children with nonneurogenic bladder problems.
OBJECTIVE
The bladder cooling test (BCT) engages a primitive neonatal spinal reflex that becomes suppressed by descending signals in older children and may reappear with suprasacral lesions. We assessed the outcome of the BCT in a large group of children with nonneurogenic bladder problems.


METHODS
The BCT was evaluated in a consecutive series of 178 girls and 106 boys, 1 month to 18 years old with bladder problems without overt neurology. The test was performed at the end of routine cystometry by a rapid control infusion of body warm saline followed, after fluid evacuation, by the same volume of cold saline (3 to 10C). The test was considered positive if a detrusor contraction greater than 30 cm H2O was evoked by the cold but not the warm fluid.


RESULTS
Most children younger than 4 years had a history of pyelonephritis (29 of 34) and/or had vesicoureteral reflux (grade IV to V in 26 of 34). For those younger than 2 years 87% of the BCTs were positive while only 21% of the tests were positive in 2 to 3-year-old children. Most children older than 4 years had idiopathic urge incontinence, and greater than 50% of the BCTs were positive in the youngest (less than 6 years) with a gradual decline to 0% at age 13 years.


CONCLUSIONS
Conversion of positive to negative BCTs at about age 2 years presumably represents normal maturation while positive tests in older incontinent children suggest delayed maturation of the central neuronal control of the bladder.
Department of Molecular and Clinical Medicine, Division of Pediatrics, Faculty of Health Sciences, SE-581 85 Linköping, Sweden. gunilla.gladh@lio.se
Gunilla
G
Gladh
Sven
S
Mattsson
Sivert
S
Lindström
D000293:Adolescent; D000375:Aging / Q000502:physiology; D002648:Child; D002675:Child, Preschool; D003080:Cold Temperature; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009119:Muscle Contraction; D012018:Reflex; D013116:Spinal Cord / Q000503:physiopathology; D001743:Urinary Bladder / Q000294:innervation / Q000503:physiopathology*; D001745:Urinary Bladder Diseases / Q000503:physiopathology*