The 50-Year History of the Ice Water Test in Urology

Purpose

The ice water test was first described in a 1957 study of cold receptors in the bladder. We examined the role of the ice water test in the diagnosis and management of different urological conditions.

Materials and Methods

MEDLINE® and PubMed® literature searches were performed, spanning 1956 to January 2009. Other studies were identified by reviewing secondary references in the original citations.

Results

The ice water test has been shown to be a lower motoneuron segmental reflex involving C-fiber afferents, which are associated with cold receptors. A number of its clinical applications have been described. The test was first thought to be specific to upper motoneuron lesions but patients with other urological conditions have had a positive test, including those with nonneurogenic disorders. The test is almost always negative (contractions less than 15 cm H₂O) in healthy volunteers and in patients with stress urinary incontinence, lower motoneuron conditions and bladder pain syndrome. In cases of upper motoneuron conditions the positive test rate is 46% to 92% depending on the underlying pathological condition.

Conclusions

The ice water test has several potential applications but it is not needed in routine clinical practice. To date the main interest has been in patients with neurogenic bladder disorders. Further studies to investigate the validity and reliability of the ice water test in patients with idiopathic detrusor overactivity could prove useful.

Key Words: urinary bladder, diagnostic tests, routine, urodynamics, nerve fibers, unmyelinated, ice

Abbreviations and Acronyms: BOO, bladder outlet obstruction, BPS, bladder pain syndrome, DO, detrusor overactivity, IDO, idiopathic DO, IWT, ice water test, LMN, lower motoneuron, MS, multiple sclerosis, SUI, stress urinary incontinence, TRP, transient receptor potential, UDS, urodynamics, UMN, upper motoneuron