척수손상 환자의 신경인성 방광 평가에서 찬물 요류동태 검사

Abstract

Objective To determine the clinical utility of ice water test for the urodynamic study in neurogenic bladder of spinal cord injured patients.

Method Warm water (20∼30oC) urodynamic studies were performed on 66 spinal cord injured patients. Subsequently, ice water (4∼8oC) urodynamic studies were performed. We determined the ice water test to be positive if the reflex volume of ice water urodynamic study is lower than the volume of the warm water urodynamic study.

Results Ice water test was positive in 24 (55.8%) and negative in 19 (44.2%) of the 43 patients showing hyperreflexic detrusor activity in warm water urodynamic study. Ice water test was negative in all 23 cases showing areflexic detrusor activity. No significant difference was found between positive and negative ice water test groups for the level of injury, sex, age, extent of injury and duration since injury. If water was cool enough, positivity of ice water test was not affected by infusion rate. There was no difference between the two urodynamic studies of maximal bladder pressure and compliance.

Conclusion This study suggests that ice water urodynamic study is a useful method for the evaluation of hyperreflexic neurogenic bladder activated by cold specific receptors via C afferent fibers in spinal cord injured patients