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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., Patient and 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%., Conclusion: 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., (Copyright © 2010 Elsevier Masson SAS. All rights reserved.)

Purpose: We describe the effect of intravesical ice water instillation in patients with multiple sclerosis and without an overactive bladder., Materials and Methods: Of 131 consecutive patients with multiple sclerosis who presented with a urinary disorder we selected for study 10 men and 29 women with a mean age plus or minus standard deviation of 50 +/- 9 years who had multiple sclerosis without an overactive bladder. Nonoveractive bladder was defined as no involuntary detrusor contraction up to 400 ml. of maximum fill on routine cystometry. We performed cystometry with saline at 25 to 30C at an infusion rate of 50 and 100 ml. per minute, and with ice water at 0 to 4C at a rate of 100 ml. per minute. Ice water cystometry was considered positive when an involuntary detrusor contraction occurred before 200, and between 200 and 400 ml. of filling. Ice water cystometry was considered negative when there was no involuntary detrusor contraction during ice water filling up to 400 ml., Results: Ice water cystometry enabled us to elicit involuntary detrusor contractions in 21 patients, which remained undetected by warm water cystometry at rates of 50 and 100 ml. per minute. The test was positive before 200, and between 200 and 400 ml. in 10 and 11 cases, respectively. Positive ice water cystometry was significantly associated with irritative signs or significant post-void residual urine volume., Conclusions: An involuntary detrusor contraction was not elicited by cystometry at 50 or 100 ml. per minute, implying that the afferent mechanoreceptor reflex limb via ADelta fibers is not involved. In contrast, ice water cystometry at 100 ml. per minute elicited an involuntary detrusor contraction, suggesting involvement of an afferent reflex limb via capsaicin sensitive C fibers. These involuntary detrusor contractions revealed by ice water cystometry are probably relevant to an overactive bladder. In urinary disorders such a positive test indicates a spinal lesion. In multiple sclerosis it may have pathophysiological value, indicating a spinal rather than cerebral mechanism of overactive bladder, and diagnostic value, indicating multifocal demyelination.