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.
Gladh
Gunilla
G
Department of Molecular and Clinical Medicine, Division of Pediatrics, Faculty of Health Sciences, SE-581 85 Linköping, Sweden. gunilla.gladh@lio.se
Mattsson
Sven
S
Lindström
Sivert
S
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*