Neuropathic Bladder, Urinary Bladder, Neurogenic
Conditions
Keywords
Lower urinary tract, Bladder, Neuropathic bladder, Overactive bladder
Brief summary
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.
Detailed description
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.
Interventions
PROCEDUREIce-water-test
Sponsors
Balgrist University Hospital
Study design
Allocation
RANDOMIZED
Intervention model
CROSSOVER
Primary purpose
BASIC_SCIENCE
Masking
DOUBLE (Subject, Investigator)
Eligibility
Sex/Gender
ALL
Age
18 Years to 90 Years
Healthy volunteers
No
Inclusion criteria
* neurogenic lower urinary tract dysfunction * urodynamic investigation * written informed consent * ≥ 18 years old
Exclusion criteria
* symptomatic urinary tract infection * \< 18 years old * ≥ 90 years old * no written informed consent * pregnancy
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Increase of detrusor pressure in cmH20 | 60 minutes | Increase of detrusor pressure during the verum ice-water-test and the placebo ice-water-test (intravesical pressure increase during the filling of the bladder with 4°C or 36°C water) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Sensations (yes/no) | 60 minutes | Coldness, Urgency, Pain, Information with yes or no |
| Urinary incontinence | 60 minutes | Urinary incontinence during the test |
| Heart rate | 60 minutes | Assessment of the heart rate during the test |
Countries
Switzerland
Outcome results
None listed