Special UDT Tests

and Apichana Kovindha²

(1)

University of Antwerp, Antwerp, Belgium

(2)

Rehabilitation Medicine, Chiang Mai University, Chiang Mai, Thailand

Some special tests, such as ice water test or bethanechol super sensitivity test, have fallen in disuse, though they may have clinical value as reported demonstrated in literature.

13.1 Ice Water Test

The Ice water test (IWT) is based on the principle that introducing cold water (4°) into the bladder can elicit a spinal reflex contraction of the detrusor when inhibition by supraspinal centres is disturbed, as with SCI.

Originally described as bedside technique, a simultaneous measurement of intravesical pressure permits to rule out false negative tests. A positive test has been shown in 95% of patients with complete and 91% of those with incomplete suprasacral lesion. All patients with LUT denervation had a negative IWT [8–9]. Repeating the IWT has been shown to increase its positivity [10]. After sphinal shock, watch out for autonomic dysreflexia (AD) in those with spinal cord lesion at or above T6.

13.2 Bethanechol Super Sensitivity Test

This test was developed to distinguish between a neurologic and a myogenic aetiology of hypocontractile detrusor. Positive results have been described in neurologic and non-neurologic detrusor areflexia with sensitivity of 90%, and specificity of 95.6% [11]. Literature cautions on many variables which influence the outcome of the test. Application should be only subcutaneous. Strong general reactions due to excess parasympathetic stimulation has been described.

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