The Study of Factors in Cystometry and Ice Water Test

Moon, Hyun; Kim, Hyung Jee; Lee, Gil Ho

Abstract

PURPOSE: The goal of cystometry is the reproduction of the patient's clinical status to improve diagnosis and therapy. However practitioner should know that various factors such as temperature and speed of saline infusion can change the cystometry finding. The ice water test(IWT) is known as a simple method that it discriminate between upper and lower motor neuron lesion. The aim of this study is to clarify the relationship of factors occurred during cystometry and the usefulness of IWT. Materials and Methods: On the first study(Apr 1997 to Jun 1997), cystometry was performed in 60 patients with voiding difficulty. In this study we determined cystometry finding according to alteration of temperature(1 degrees C, 37 degrees C) and speed (20ml/min, 50ml/min) of saline infusion during consecutive cystometry. On the second study(Jun 1997 to Aug 1997), IWT was performed in 68 patients with voiding difficulty. The IWT was performed after cystometry with the patient in the supine position. The bladder was completely emptied, and 100ml of sterile 1 degrees C saline was infused within 250-300ml/min. In patient with a maximal cystometry capacity below 200ml, a volume of about half the capacity was infused. The test was considered positive if a sustained bladder contraction above 20cmH2O was registered or some of the cold saline was expelled within 1 minute.
RESULTS
There was no relation between speed and temperature of infused saline about maximal bladder capacity, detrusor pressure and compliance during cystometry. Positive result of IWT was found in 31 (54.4%) among 57 patients with neurologic lesion and in 29(63.0%) among 46 patients with upper motor neuron lesion. In contrast, 10(90.9%) among 11 patients with non-neurological lesion and 8(72.7%) among 11 patients with lower motor neuron lesion was negative. Specificity for discrimination of upper motor neuron lesion and lower motor neuron lesion was 72.7%.
CONCLUSIONS
It is concluded that cystometry finding was no relation between speed and temperature of infused saline about maximal bladder capacity, detrusor pressure and compliance during consecutive cystometry. The IWT is a simple supplementary urodynamic test that increases the precision of the diagnosis of upper motor neuron lesion. Thus, it was close enough to be used as a available procedure for subclinical upper motor neuron lesion.