Positive ice-water test: a predictor of neurological disease?

The urinary bladder is equipped with a reflex system including cold receptors of the bladder wall and having reflex pathways partly separate from the normal micturition reflex. The ice-water test involves cooling of the bladder wall with ice-cold saline solution. In the neurologically intact adult the test is negative. A positive test indicates overt or occult neuropathy. In this report, examples are given of patients presenting with bladder symptoms and a positive test but initially lacking signs of a neurological condition. During follow-up, various neurogenic diseases appeared. It is suggested that a positive ice-water test may represent a negative prognostic urodynamic sign along with a potential risk for neurogenic disease to come.