The value of the ice water test in the management of the neurogenic bladder.

Ice water tests (IWT) and gas cystometrograms were performed on 30 consecutive spinal cord injury in-patients on an intermittent catheterization program over a 6-month period. The tests were used to determine the presence of bladder reflex activity. A three-step grading system was formulated to clinically determine the degree of detrusor reflex activity on IWT. A 3+ IWT was used to indicate the expulsion of the catheter from the bladder and urethra following instillation of recently thawed ice; a 2+ IWT meant voiding around the catheter after instillation of 90 ml of ice water; and a 1+ IWT indicated voiding around the catheter after instilling a total of 300 ml of ice water into the bladder. The study shows that the ice water test was more sensitive test than CO2 cystometrogram in detecting the presence of detrusor reflex activity.