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


METHODS
Hundred 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.


RESULTS
Patients 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%.


CONCLUSIONS
Patients 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.
Deffontaines Rufin
S
S
Service de rééducation neurologique et d'explorations périnéales, Er6 UMPC, hôpital Rothschild, AP-HP, université Paris 6-Pierre-et-Marie-Curie, 33 boulevard de Picpus, Paris 12(e), France. Stephanie.deffontaines@psl.aphp.fr
Jousse
M
M
Verollet
D
D
Guinet
A
A
Ismael
S S
SS
Amarenco
G
G
D000328:Adult; D000368:Aged; D003080:Cold Temperature; D053159:Dysuria / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000503:physiopathology; D036421:Nerve Fibers, Unmyelinated / Q000502:physiology*; D011128:Polyradiculopathy / Q000503:physiopathology; D012021:Reflex, Abnormal / Q000502:physiology*; D012680:Sensitivity and Specificity; D013116:Spinal Cord / Q000503:physiopathology; D050053:TRPM Cation Channels / Q000502:physiology; D013697:Thermosensing; D001743:Urinary Bladder / Q000503:physiopathology*; D053201:Urinary Bladder, Overactive / Q000503:physiopathology; D014554:Urination / Q000502:physiology
D050053:TRPM Cation Channels; C425966:TRPM8 protein, human