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1st Author
and year
|
Study population
|
Number of
participants
|
IWT technique
|
Criteria for positive
IWT
|
Main results: %
is % of positive IWT
|
Balmaseda MT,
1988
21
|
Spinal cord
injury on ISC
Consecutive
admission
|
29M
1 F (11-55y)
|
90 ml in 16C h
catheter. No pressure recording. |
3 grades: +3 if
expelled catheter. +2 if leaked around catheter, +1 if leak with 300mls.
|
IWT detected 90%
of detrusor activities compared to CO2 CMG which detected 66.7%
|
Geirsson G,
1993
22
|
>65y, Sweden,
all had urgency or UUI unless had UMN disease
|
267, 89% M
|
Retrospective
study. All had IWT and water
fill cystometry + 2
minutes inhibitory test
|
Not stated
|
Three types of “OAB”:IWT
is positive in 75% of UOB, 29% of PDI and 81% of SDH
|
Geirsson G,
1993
10
|
M with +ve IWT and urgency.
2 F with SUI
|
11M (64-86y)
2 F control
|
Infusion of 100
ml saline over 20 sec, at 0-37C,
and left 1 min. Test repeated after use of Menthol
|
If detrusor contraction >20 cm H2O
|
Menthol increases
the temperature threshold of cooling reflex. Cold sensation with no pain
|
Geirsson G,
1993
23
|
Patients with +ve IWT 12/16 had NDO,
|
14 M: 2F (23-94y)
|
100ml (or ½
bladder capacity if small) |
If detrusor contraction >20 cm H2O
|
Some patients had
cooling reflex elicited with fluid at 20C but most 13/16 started at 10C.
|
Geirsson G,
1993
24
|
Had CMG and IWT
1986-88
|
396 M
133 F
(17-93y)
|
Retrospective
study. Supine position. |
If water expelled
and sustained detrusor contraction, false -ve if contraction equal or more than the voiding pdet but without leak
|
97% of UMN had +ve IWT or false –ve
47% of unstable detrusor (idiopathic) had +ve test,
All of the LMN
and SUI had –ve test
|
Geirsson G,
1994
7
|
Consecutive
referred for UDS, 28 had neurological condition.
|
51M
50F
(18-92y)
|
Different
volumes, 8 patients were tested
with different speeds (25, 60, 120, 180,
200
and 300ml/min) and temps 0-2 C, supine. |
If water expelled
and sustained detrusor contraction, false -ve if contraction equal or more than the voiding pdet but without leak
|
IDO 10/73
positive
NDO 28/28
positive
No DO 0/71
positive
|
Petersen T,
1996
25
|
Consecutive pts
with no BOO
|
60 “detrusor hyperreflexia”,
20 “detrusor instability”
|
100 ml (half of
bladder volume at maximum
desire if <200) of 0-2 n saline 15-20s, and
|
DO defined when
contraction of >15 cm H2O.
+ve IWT if > 30cm H2O or leak, or >20 with low micturition pressure
|
DH 39/60 =65% positive
Infrapontine DH 70%, suprapontine 46% positive
IDO 3/20=15%
positive
|
Ishigooka M,
1997
26
|
Group 1: CVA with
UOB, no BOO
Group 2: BOO with
DO
|
G1: 18M:14F
G2: 16M
|
100 ml or half the
capacity if it was |
+ve if detrusor contraction of >30cm H2O,
|
G1: 62.5% +ve IWT, More +ve if pontine lesions compared
to multiple cerebral infarctions.
G2: BOO had 6.3% +ve IWT
|
Ronzoni G,
1997
27
|
G1: Traumatic neurology
lesion in subacute phase
G2: neurogenic bladder
|
G1: 148
G2: 130
|
30% of capacity,
200ml/min, supine, 4C water, 1 min.
|
If expel catheter
or leak.
False –ve if >20 cm H2O contraction with no leak
|
UMN 95%, LMN 0,
MS 74%, Parkinson 58%
These included
false -ve
|
Chancellor MB,
1998
28
|
Consecutive SCI.
24 had external sphincter ablation surgery
|
31M, 1F
(19-52, mean 35y)
|
100 ml saline or
50% capacity, 3 min, 4-8C. Repeated in 2 weeks
|
+ve if ≥15 cm H2O, supine
|
Not consistent,
73%. 100% for UDS
|
1st Author
and year
|
Study population
|
No
|
IWT technique
|
Positive test
|
Main result: % is
% of positive IWT
|
Chai TC,
1998
29
|
Consecutive
patients attending for UDS. 51 neurogenic
|
68F, 43M
(33-78, mean 59y)
|
50ml/min, up to
250ml saline infused. 0C
|
+ve if >15 cm or leak.
same criteria to
define DO
|
IWT could be
useful in predicting TURP outcome (see text)
|
Ismael SS,
2000
30
|
G1: Consecutive
MS, no DO on routine UDS
G2: MS with DO
|
G1: 10M 29 F
mean 50+/-9y
G2: 92
|
100ml/min up to
400 mls. Stopped if leak , 0-4C of saline, in
supine and kept for 1 min
|
+ if >15 cm
|
G1: 54%. (26% in
the first 200ml)
G2: all +ve
IWT more
sensitive than filling CMG in detecting DO.
|
Sundstrom S,
1990
31
|
Post TURP with
LUTS
|
15 M
|
Ice saline
filling UDS.
|
Not stated
|
Cold filling UDS
represent better correlation with symptoms
|
Hellstom PA,
1991
32
|
G1: consecutive
patients
G2: healthy
control
|
G1: 375
G2: 25
|
100ml of saline
over 20 sec, 0C, supine, left in for 5-8 min
|
+ve at three levels
I- if 0-2cm H2O
II- 3-14
III- >=15
|
If >15 cm: patients
with DO of any type 56%, LMN 2%, UMN 50%, “motor urgency” 46, BOO 16, areflexia 3, 0% in healthy or SI or normal UDS.
If >3 then DO
87%, LMN 37, UMN 73, normal 44
|
Tammela TL,
1992
33
|
Patients waiting
for TURP. No neurology
|
73 (48-80, mean
64y)
|
100ml, 0C over
20s, left in for 5-8 min., in supine position.
|
DO if >15.
+ve>=15cm.
|
14/ 44 (32%) with
DO
|
Hirayama A,
2005
34
|
BOO with no
neurological condition, IPSS >=8, Qol>=2, over 50y
|
114 M
|
100ml of iced
saline, filling rate 300ml/min. if DO observed at less than 100ml, two third
of the amount was instilled.
|
If detrusor contraction >15 cm H2O
|
0/67 with no DO
28/47 (60%) with
DO
+ve IWT associated with nocturia ≥3 times
|
Mukerji G,
2006
35
|
G1 IDO
G2: bladder pain syndrome
G3: NDO
G4: USI, no DO
|
Females age 28-65
G1: 22
G2: 17
G3: 4
G4: 21
|
0-4C, maxim
100mls, rate 50ml/min. left in for 1 min.
|
If involuntary uninhibited detrusor contraction evoked and associated with
urgency or with fluid expulsion.
|
G1: 27%, G2: 0,
G3: 100%
G4: 0. IWT causes
pain to BPS patients only, might be marker to assess efficacy of treatment.
|
Wyndaele J,
2004
36
|
OAB, excluded neurogenic or
BOO. All had IDO
|
23F:22M
|
60mls of Urografin 30% at 4C, over 5-10 sec. repeated until +ve test, maximum 3 times. Supine position
|
Criteria not
mentioned
|
All –ve IWT. No difference if pts
feel the DO or not during the UDS
|
Van Meel TD,
2007
37
|
G1: Neurogenic DO
G2: IDO no BOO
G3: USI no DO
|
G1: 25F:38M
G2: 69F:48M
G3: 30F
|
60mls of Urografin 30% at 4C, over 5-10 sec, repeated until +ve test maximum 3 times. Supine position
|
If a detrusor contraction was elicited.
|
G1: 46-86%
G2: 7-24%
G3: 0. Repeated
tests increased sensitivity
|
Table
2: methods and criteria used to define positive IWT in various publications.
UOB: “uninhibited overactive bladder”. PDI: “phasic detrusor instability”, SDH: “spinal detrusor hyperreflexia”. DI: detrusor “instability”. SCI: spinal cord injury. UDS:
urodynamics. SI: stress incontinence.
Condition
|
Number
of patients included
|
(%)
of positive IWT
|
First
author
|
Upper
Motor Neuron (UMN)
|
558
77
261
126
|
90
46-73*
84
92
|
Bors
38
Hellstrom
32
Geirsson
47
Ronzoni
27
|
Multiple
Sclerosis (MS)
|
42
37
|
74
76
|
Ronzoni
27
Geirsson
47
|
Cerebrovascular Accident (CVA)
|
32
|
62.5
|
Ishigooka
26
|
Lower
Motor Neuron (LMN)
|
Not
stated
30
22
43
|
0
0
0
2-37*
|
Bors
1
Geirsson
24
Ronzoni
27
Hellstrom
32
|
Stress
Urinary Incontinence (SUI)
|
30
30
20
33
|
0
0
0
0-18*
|
Geirsson
10,24
Van Meel
37
Mukerji
35
Hellstrom
32
|
Idiopathic Detrusor Overactivity (IDO)
|
238
45
117
22
20
|
47
0
7-24
27
15
|
Geirsson
24
Wyndaele
36
Van
Meel
37
Mukerji
35
Petersen
25
|
Painful
Bladder Syndrome) PBS
|
17
|
0
|
Mukerji
35
|
(Bladder
Outflow Obstruction (BOO)
|
80
16
17
73
114
|
16-60*
6
71
23
0
(no DO)-60 (with DO)
|
Hellstrom
32
Ishigooka
26
Chai
29
Tammela
33
Hirayama
34
|
Healthy
|
25
|
0-44*
|
Hellstrom
32
|
“Areflexic bladder”
|
58
|
3-26*
|
Hellstrom
32
|
Children
|
12
(<4yr)
38
(=>5yr)
23
(<2yr)
14
(2-3yr)
|
92
5
87
21
|
Geirsson
5
Gladh
46
|
Table
4: The rate of positive IWT in different urological conditions.
*:
The range is due to the detrusor pressure criteria
used to define positive IWT