The bladder cooling test for urodynamic assessment: analysis of 400 examinations.

The clinical significance of the bladder cooling test as one part of a standard urodynamic examination was studied in 375 consecutive patients and 25 controls. Inability to perceive cold sensation in the bladder was common in cases of neurogenic lesions and present in nearly half of the patients with outlet obstruction, some with no urodynamic abnormalities and some of the normal subjects. The bladder contractions provoked by the test were clearly associated with detrusor overactivity, as in those patients with upper motor neuron lesions of motor urgency, but 27% of such patients showed no response. In 7 cases the iced water provoked detrusor contractions when cystometry showed no overactivity. This clinical series confirms that the cold receptors found recently in animal experiments are also present in the human urinary bladder. The bladder cooling test is not an alternative to cystometry, but its inclusion as an integral part of the urodynamic examination seems to be useful, especially in cases where there is also a need to study the sensibility of the bladder at the same time.