Sensation of Cold during the Ice Water Test Corresponds to the Perception of Pain during Botulinum Toxin Bladder Wall Injections

Abstract

Aims: To investigate the association of bladder cold sensation (BCS) during the ice water test (IWT) and pain perception when botulinum toxin injections (BTI) are administered into the bladder wall. Material and Methods: In 86 patients with idiopathic overactive bladder, the BCS during the IWT was investigated. Patients were divided into 2 groups: with and without BCS. During subsequent administration of BTI, the number of perceived and painful injections as well as the pain levels on a 0-100 pain scale were compared in both groups using Student t test. Results: Thirty-five patients reported a BCS, while 51 did not. After 10 BTI, the mean number of perceived injections was 7.9 in patients with and 2.4 in patients without BCS (p < 0.0001). The mean number of painful injections was 5.4 in patients with BCS and 4.3 in patients without (p < 0.001). Mean levels on a 0-100 pain scale were 33.7 in patients with and 17.8 in patients without cold sensation (p < 0.0001). Conclusion: The association of BCS during the IWT and pain to during BTI may implicate that the perceptions of cold and pain in the urinary bladder may use similar receptors and neuronal pathways.

Interventions to improve tolerability of local anesthetic intradetrusor Botulinum toxin injections: A systematic review

“…Consequently, larger studies identifying which subgroups of patients tolerate the procedure most poorly would be valuable as these patients would benefit the most from the interventions identified in this review. Reitz et al 38 found a notable increase in bladder sensation and pain perception in patients who exhibited bladder cold sensation when tested with ice water instillation. Understanding which patients experience bladder cold sensation may allow the prediction of lower tolerability as well.…”

“…This review identified three studies that identified that reducing the number of injections reduced pain scores. 20,21,26 The sample size was however small for all three studies (range [25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40]. Two of these studies also assessed whether fewer injections were associated with a reduction in effectiveness.…”