The 50-Year History of the Ice Water Test in Urology

PurposeThe ice water test was first described in a 1957 study of cold receptors in the bladder. We examined the role of the ice water test in the diagnosis and management of different urological conditions.Materials and MethodsMEDLINE® and PubMed® literature searches were performed, spanning 1956 to January 2009. Other studies were identified by reviewing secondary references in the original citations.ResultsThe ice water test has been shown to be a lower motoneuron segmental reflex involving C-fiber afferents, which are associated with cold receptors. A number of its clinical applications have been described. The test was first thought to be specific to upper motoneuron lesions but patients with other urological conditions have had a positive test, including those with nonneurogenic disorders. The test is almost always negative (contractions less than 15 cm H2O) in healthy volunteers and in patients with stress urinary incontinence, lower motoneuron conditions and bladder pain syndrome. In cases of upper motoneuron conditions the positive test rate is 46% to 92% depending on the underlying pathological condition.ConclusionsThe ice water test has several potential applications but it is not needed in routine clinical practice. To date the main interest has been in patients with neurogenic bladder disorders. Further studies to investigate the validity and reliability of the ice water test in patients with idiopathic detrusor overactivity could prove useful.