Positive Bladder Cooling Test in Neurologically Normal Young Children

Abstract

The bladder cooling test, which consists of rapid infusion of 0 to 8C saline into the bladder with simultaneous pressure measurement, was performed in 50 neurologically intact infants and children 6 months to 13 years old. The patients were referred for urodynamic investigation because of various disorders of the lower urinary tract. A positive bladder cooling test was defined as a sustained reflex detrusor contraction of about the same magnitude as the micturition contraction. The test was positive during the first 4 years of life but typically negative in children older than 5 years. These findings indicate that a positive bladder cooling test is an infant reflex response that, with the maturation of the central nervous system, becomes suppressed by descending signals from higher centers.

Positive ice-water test: a predictor of neurological disease?

“…In the neurologically healthy adult the IWT is negative, whereas the test is positive in infants and children up to the age of 4 years [8]. In the adult a positive test may be regarded as a sign of neuropathy, hidden or overt.…”

“…At this stage, trials using the I W T systematically in urodynamics are scant [10]. A positive I W T is caused by activation of the bladder-cooling reflex, which is elicited from cold receptors in the bladder wall [4,5] and appears to represent a primitive reflex brought under inhibitory control at the age of about 4 years [8]. The reflex m a y be triggered by specific lesions within the CNS, affecting pathways of significance for bladder control, a p h e n o m e n o n similar to the induction of the Babinski sign in pyramidal tract lesions.…”

Bladder cooling reflex and external urethral sphincter activity in the anesthetized and awake guinea pig

“…The bladder cooling reflex is readily evoked in awake healthy infants but fails to appear in most children after the age of four [11,12]. It is unmasked by the supraspinal or high spinal lesions in man, as originally found by Bors and Blinn [1].…”

“…The bladder cooling reflex is readily evoked in infants [11,12] but becomes suppressed by the descending signals from higher centers when the child gains voluntary control of its bladder. This means that the bladder cooling reflex is an infant reflex response which may be unmasked by the central lesions in adults with concealed or overt neurological disorders [4,13].…”

A Nomogram to Characterize the Severity of Detrusor Overactivity during the Ice Water Test: Description of the Method and Proof of Concept

“…This reflex is mediated by type C afferents that interact with bladder motoneurons in the sacral cord [3]. Until the age of 4, the bladder cooling reflex is a physiological phenomenon; after the age of 5, with the maturation of the central nervous system, it becomes suppressed by descending signals from higher centers [4]. Similar to the Babinski’s reflex, a reappearance of the reflex in older children or adults may indicate a lesion of the spinal cord or supraspinal centers [5, 6].…”