Urodynamic investigations in patients with spinal cord injury: should the ice water test follow or precede the standard filling cystometry?

Abstract

Objectives: To evaluate whether the ice water test (IWT) should be performed before or after the standard urodynamic investigation (UDI). Patients and Methods: Two cohorts of patients suffering from neurogenic lower urinary tract dysfunction (NLUTD) due to spinal cord injury (SCI) were matched by lesion level and age. The patients of cohort A (n = 55, retrospective cohort) underwent the IWT before and the patients of cohort B (n = 110, prospective cohort) after standard UDI. The IWT effect on urodynamic parameters has been compared between the two groups using the Mann-Whitney U-test for independent samples. UDI was performed according to good urodynamic practices recommended by the International Continence Society. Results: The mean age of both cohorts was 49 years. Performing the IWT before versus after standard UDI resulted in a significantly lower maximum cystometric bladder capacity (P = 0.01), lower incidence of detrusor overactivity (P = 0.017) and lower maximum detrusor pressure during IWT (P = 0.04). All other urodynamic parameters assessed demonstrated no significant difference (P40.05). Conclusions: Our results are in line with findings from animal studies demonstrating a bladder cooling-induced gating effect on the micturition reflex volume threshold on the level of sacral interneurons. Since the IWT is an unphysiological investigation that might significantly bias subsequent urodynamics, we suggest that the IWT should not precede more physiological standard UDI.

Urodynamics in patients with spinal cord injury: A clinical review and best practice paper by a working group of The International Continence Society Urodynamics Committee

“…We identified a specific SCI‐based study. Recently, Kazomara et al evaluated whether the ice water test (IWT) should be performed before or after the standard UDS. Two cohorts of patients suffering from neurogenic lower urinary tract dysfunction (NLUTD) due to SCI were matched by lesion level and age.…”

Use of the ice water test as an early predictor of recovery of erectile function in patients with spinal cord injury

“…In the literature, the criteria on which a positive IWT are based are heterogenous: amplitude of the DC, filling speed, perfusion volume required to trigger it, the water temperature (pre and post IWT) and time before interpretation all vary [25]. We chose to use the most commonly reported values of 30 cm H 2 O, at a volume above 50% of the cystometric volume, with a filling speed of 100 ml/min to define DC during the IWT.…”

Is Detrusor Contraction during Rapid Bladder Filling Caused by Cold or Warm Water? A Randomized, Controlled, Double-Blind Trial

“…P atients underwent two fast filling cystometries (IWT and WWT) after standard UDI according to our previous study. 14 The IWT was conducted with 4°C and the WWT with 36°C saline with a filling speed of 100 mL/min upon the occurrence of a detrusor contraction or upon a maximum bladder filling volume of 500 mL. The effect of the order of IWT and WWT on occurrence of detrusor overactivity, maximum detrusor pressure, maximum bladder filling volume and maximum heart rate was analyzed using an ANOVA for repeated measures with within factor "temperature" (cold versus warm) and between factor "order" (cold first versus warm first).…”