Urinary Bladder, Neurogenic Clinical Trial
Official title:
Is the Detrusor Contraction During the Ice-water-test Provoked by the Ice Water or the Rapid Bladder Filling? A Randomized, Double-blind Clinical Trial
In this randomized, double-blind clinical trial including patients with a neurogenic lower urinary tract dysfunction undergoing urodynamic investigation at the Spinal Cord Injury Center, Balgrist University Hospital, Zürich, we aim to investigate whether the detrusor contraction during the ice-water-test is provoked by the ice water or the rapid filling.
The ice-water-test (IWT) was first described 1957 by Bors and Blinn and it was thought to
differentiate between lesions of the upper and lower motoneuron. In cat studies, it was shown
that the IWT is a C-fiber mediated lower motoneuron segmental reflex and that these
unmyelinated C fibers are associated with cold receptors. This explains the positive IWT in
patients with upper motoneuron lesions. In healthy humans, the IWT is positive up to the age
of 4 years and becomes negative thereafter since the reflex is centrally inhibited. However,
this reflex might be unmasked by a neurological disease and/or injury.
Considering that C-fibers are involved in the pathogenesis of detrusor overactivity, the IWT
seems to be a useful diagnostic tool in daily practice. However, although there are many
studies published on the IWT, it is unclear whether the detrusor contraction during the IWT
is provoked by the ice water or whether it might be caused by the rapid filling. Therefore,
we designed this randomized, double-blind trial.
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