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Eiswassertest und Bladder-cooling-Reflex

Physiologie, Pathophysiologie und klinische Bedeutung

The ice water test and bladder cooling reflex

Physiology, pathophysiology and clinical importance

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Zusammenfassung

Hintergrund

Urodynamische Messungen werden zur Diagnostik und Verlaufskontrolle von Funktionsstörungen des unteren Harntraktes eingesetzt. Provokationstests dienen dabei zur Demaskierung von Funktionsstörungen, die in der Standardzystometrie nicht nachweisbar sind. Der Eiswassertest ist ein Provokationstest, um eine neurogene Ursache für eine Blasenüberaktivität nachzuweisen.

Ziel

Darstellung der Entwicklung und Bedeutung des Eiswassertests vor dem Hintergrund des aktuellen Wissens über die Physiologie und Pathophysiologie der Funktion des unteren Harntraktes.

Material und Methode

Es erfolgte im April 2015 eine systematische Literaturrecherche in den Datenbanken Pubmed und ScienceDirect. Relevante Literatur ohne Jahresbegrenzung oder Sprachlimitierung wurde in den Datenbanken selektiert. Folgende Schlagwörter und „medical subject heading“ wurden zur Literaturrecherche verwendet: „ice water test“, „bladder cooling reflex“, „micturition“ und „neuronal control“. Übersichtsartikel und Literaturverzeichnisse wurden verwendet, um weitere relevante Literatur zu identifizieren.

Ergebnisse

Der Eiswassertest erfolgt durch rasche Instillation von 4–8 °C kalter Flüssigkeit in die Harnblase. Sofern eine unwillkürliche Detrusorkontraktion auftritt, wird er als positiv gewertet. Pathophysiologisch werden über Kälterezeptoren im Urothel afferente C-Fasern aktiviert, die den sog. Bladder-cooling-Reflex auslösen. Der Reflex wird jedoch beim Gesunden ab spätestens dem 5. Lebensjahr durch das zentrale Nervensystem inhibiert.

Diskussion

Der Eiswassertest ist ein Provokationstest zur Demaskierung suprasakraler Nervenschädigungen als Auslöser einer Detrusorhyperaktivität. Bei einer Detrusorakontraktilität hingegen ist der Eiswassertest stets negativ. Er kann hierbei nicht zur Unterscheidung einer neurogenen oder muskulären Ursache herangezogen werden. Darüber hinaus fällt der Test zudem bei einem geringen Prozentsatz bei nicht-neurologischen Blasenfunktionsstörungen positiv aus, so z. B. bei der prostatabedingten Blasenauslassobstruktion oder der idiopathisch überaktiven Blase. Die Ursache hierfür ist nicht abschließend geklärt, kann aber möglicherweise als erstes Anzeichen einer anderweitig asymptomatischen neurologischen Erkrankung gewertet werden.

Schlussfolgerung

Aufgrund der einfachen Durchführung bietet der Eiswassertest eine einfache und schnelle Möglichkeit neurologische Detrusorhyperaktivitäten im Anschluss an die Standardzystometrie zu identifizieren.

Abstract

Background

Urodynamic studies are utilised for identification and follow-up of functional disorders of the lower urinary tract. Provocation tests are used to determine disorders which could not be revealed in standard cystometry. The ice water test is a simple test to identify neurogenic bladder dysfunction and to screen the integrity of the upper motor neuron in neurogenic bladder dysfunction.

Objectives

Development and significance of the ice water test is presented in this review against the background of physiology and pathophysiology of the lower urinary tract.

Materials and methods

A systematic review of PubMed and ScienceDirect databases was performed in April 2015. No language or time limitation was applied. The following key words and Medical Subject Heading terms were used to identify relevant studies: “ice water test”, “bladder cooling reflex”, “micturition” and “neuronal control”. Review articles and bibliographies of other relevant studies identified were hand searched to find additional studies.

Results

The ice water test is performed by rapid instillation of 4–8 °C cold fluid into the urinary bladder. Hereby, afferent C fibers are activated by cold receptors in the bladder leading to the bladder cooling reflex. It is a spinal reflex which causes an involuntarily contraction of the urinary bladder. The test is normally positive in young infants during the first 4 years of life and become negative with maturation of the central nervous system afterwards by inhibition of the reflex. The damage of the upper motor neuron causes the recurrence of the reflex in the adulthood and indicates spinal and cerebral lesions.

Discussion

The ice water test is utilised to identify lesions of the upper motor neuron. However, in the case of detrusor acontractility the test will always be negative and can not be utilized to distinguish between neurogenic or muscular causes. Furthermore, the test is also positive in a small percentage of cases of non-neurogenic diseases, e.g. in prostate-related bladder outlet obstruction or idiopathic overactive bladder. Although no clear explanation exists, a positive ice water test could be the first sign of an otherwise asymptomatic neurological disease.

Conclusions

Due to the simple procedure, the ice water test is a reliable possibility to identify neurologic bladder hyperactivity subsequent to standard cystometry.

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Abb. 1

Abbreviations

CGRP:

„calcitonin gene-related peptid“

CMR1:

„cold and menthol receptor 1“

NO:

Stickstoffmonoxid

TRP:

„transient receptor potential“

TRPM8:

„transient receptor potential subfamily M member 8“

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Einhaltung ethischer Richtlinien

Interessenkonflikt. T. Hüsch, T. Neuerburg, A. Reitz und A. Haferkamp geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. Klinik für Urologie und Kinderurologie, Universitätsklinikum Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Deutschland

    T. Hüsch, T. Neuerburg & A. Haferkamp

  2. Kontinenzzentrum Hirslanden, Zürich, Schweiz

    A. Reitz

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  1. T. Hüsch
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  2. T. Neuerburg
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  3. A. Reitz
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  4. A. Haferkamp
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Correspondence to T. Hüsch.

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Hüsch, T., Neuerburg, T., Reitz, A. et al. Eiswassertest und Bladder-cooling-Reflex. Urologe 55, 499–505 (2016). https://doi.org/10.1007/s00120-015-3981-2

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