The Bladder Cooling Test
It is well recognized that people, especially those with detrusor overactivity, will note an increase in urinary urgency and frequency when exposed to cold. Studies in felines have demonstrated specific cold receptors in the bladder which when stimulated with low volumes of an iced solution will trigger an immediate bladder emptying reflex. This reflex occurs at bladder volumes and pressure thresholds well below those of tension receptors in the bladder suggesting an afferent limb different from that associated with the micturition reflex and detrusor overactivity. Bors originally described the classical ice water test in 1956 to distinguish between parasympathetic upper motor neuron lesions and lower motor neuron lesions. Instillation of 100 ml of sterile ice water through an 18F catheter led to rapid expulsion of the catheter and/or fluid within 10 s in patients with suprasacral lesions but was negative in those with sacral or peripheral lesions.
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