title: Usefulness of ice water test to unmask detrusor overactivity.
abstract: OBJECTIVE
  Ice Water Test (IWT) is not frequently used today. IWT triggers a non-inhibited involuntary detrusor contraction (NIDC) when the bladder is being filled with cold saline solution. NIDC is unmasked via a segmental reflex loop different from the physiological micturition reflex. Our purpose was to search for usefulness of IWT to expose detrusor overactivity (DO).
  
  
  METHODS
  One hundred and seventy-nine IWT performed in patients with overactive bladder syndrome (OAB) and conventional cystometry (CC) non-contributive to diagnosis were retrospectively analyzed. An increase of detrusor pressure of 15cm H2O allowed defining positive IWT (with leakage) or intermediate (without leakage).
  
  
  RESULTS
  The population comprised of 131 women (58.2±17.3 years) and 48 men (56.1±15.3 years). Main complaints were mixed or urge incontinence (76/179). Hundred and twenty-four patients had a history of neurological disease. From CC, detrusor behavior was founded uncategorized for 106, normal for 53 patients and underactive for 20. These results did not contribute to diagnose a DO. IWT was positive for 22 patients and intermediate for 20. DO was unmasked by IWT for 42 patients (23.4%) of whom 34 had neurological disease. The positive predictive value was 80.9%, the negative predictive value was 34.3%.
  
  
  CONCLUSIONS
  In patients with OAB syndrome, IWT is contributory to unmask DO when CC is not contributive. Our study underlines the interest to perform IWT when urodynamic diagnosis is unclear.
authors.affiliation: Service de MPR neurologique, hôpital Rothschild, AP-HP, 5, rue Santerre, 75012 Paris, France. Electronic address: karine.loiseau@rth.aphp.fr.
authors.forename: K
authors.initials: K
authors.lastname: Loiseau
authors.affiliation: Service de MPR neurologique, hôpital Rothschild, AP-HP, 5, rue Santerre, 75012 Paris, France; Université Pierre-et-Marie-Curie, Paris 06, 75005 Paris, France.
authors.forename: F
authors.initials: F
authors.lastname: Valentini
authors.affiliation: Service de MPR neurologique, hôpital Rothschild, AP-HP, 5, rue Santerre, 75012 Paris, France; Université Pierre-et-Marie-Curie, Paris 06, 75005 Paris, France.
authors.forename: G
authors.initials: G
authors.lastname: Robain
mesh_terms: D003950:Diagnostic Techniques, Urological; D005260:Female; D006801:Humans; D007053:Ice; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D053201:Urinary Bladder, Overactive / Q000175:diagnosis*
chemical_list: D007053:Ice
keywords: Bladder cooling reflex; Ice water test; Neuro-urologie; Neurogenic bladder; Test à l’eau glacée; Urodynamics; Urodynamique; Vessie neurologique