Pain during ice water test distinguishes clinical bladder hypersensitivity from overactivity disorders
<p>Abstract</p> <p>Background</p> <p>The Bladder cooling reflex (BCR) i.e. uninhibited detrusor contractions evoked by intravesical instillation of cold saline, is a segmental reflex believed to be triggered by menthol sensitive cold receptors in the bladder wall, with...
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doaj-086b6d99298144dca32192f623a8aa922020-11-24T22:30:23ZengBMCBMC Urology1471-24902006-12-01613110.1186/1471-2490-6-31Pain during ice water test distinguishes clinical bladder hypersensitivity from overactivity disordersBountra ChasChessell Iain PWaters JanetMukerji GauravAgarwal Sanjiv KAnand Praveen<p>Abstract</p> <p>Background</p> <p>The Bladder cooling reflex (BCR) i.e. uninhibited detrusor contractions evoked by intravesical instillation of cold saline, is a segmental reflex believed to be triggered by menthol sensitive cold receptors in the bladder wall, with the afferent signals transmitted by C fibres. The BCR is a neonatal reflex that becomes suppressed by descending signals from higher centres at approximately the time when the child gains full voluntary control of voiding. It re-emerges in adults with neurogenic detrusor overactivity as a consequence of loss of central descending inhibition, resulting from conditions such as spinal cord injury or multiple sclerosis. We have recently shown an increase of nerve fibres expressing the cool and menthol receptor TRPM8 in both overactive (IDO) and painful bladder syndrome (PBS), but its functional significance is unknown. We have therefore studied the bladder cooling reflex and associated sensory symptoms in patients with PBS and overactivity disorders.</p> <p>Methods</p> <p>The BCR, elicited by ice water test (IWT) was performed in patients with painful bladder syndrome (PBS, n = 17), idiopathic detrusor overactivity (IDO, n = 22), neurogenic detrusor overactivity (NDO, n = 4) and stress urinary incontinence (as controls, n = 21). The IWT was performed by intravesical instillation of cold saline (0 – 4°C). A positive IWT was defined as presence of uninhibited detrusor contraction evoked by cold saline, associated with urgency or with fluid expulsion. Patients were asked to report and rate any pain and cold sensation during the test.</p> <p>Results</p> <p>A positive IWT was observed in IDO (6/22, 27.3%) and NDO (4/4, 100%) patients, but was negative in all control and PBS patients. Thirteen (76.5%) PBS patients reported pain during the IWT, with significantly higher pain scores during ice water instillation compared to the baseline (P = 0.0002), or equivalent amount of bladder filling (100 mls) with saline at room temperature (P = 0.015). None of the control or overactive (NDO/IDO) patients reported any pain during the IWT.</p> <p>Conclusion</p> <p>The BCR in DO may reflect loss of central inhibition, which appears necessary to elicit this reflex; the pain elicited in PBS suggests afferent sensitisation, hence sensory symptoms are evoked but not reflex detrusor contractions. The ice water test may be a useful and simple marker for clinical trials in PBS, particularly for novel selective TRPM8 antagonists.</p> http://www.biomedcentral.com/1471-2490/6/31 |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Bountra Chas Chessell Iain P Waters Janet Mukerji Gaurav Agarwal Sanjiv K Anand Praveen |
spellingShingle |
Bountra Chas Chessell Iain P Waters Janet Mukerji Gaurav Agarwal Sanjiv K Anand Praveen Pain during ice water test distinguishes clinical bladder hypersensitivity from overactivity disorders BMC Urology |
author_facet |
Bountra Chas Chessell Iain P Waters Janet Mukerji Gaurav Agarwal Sanjiv K Anand Praveen |
author_sort |
Bountra Chas |
title |
Pain during ice water test distinguishes clinical bladder hypersensitivity from overactivity disorders |
title_short |
Pain during ice water test distinguishes clinical bladder hypersensitivity from overactivity disorders |
title_full |
Pain during ice water test distinguishes clinical bladder hypersensitivity from overactivity disorders |
title_fullStr |
Pain during ice water test distinguishes clinical bladder hypersensitivity from overactivity disorders |
title_full_unstemmed |
Pain during ice water test distinguishes clinical bladder hypersensitivity from overactivity disorders |
title_sort |
pain during ice water test distinguishes clinical bladder hypersensitivity from overactivity disorders |
publisher |
BMC |
series |
BMC Urology |
issn |
1471-2490 |
publishDate |
2006-12-01 |
description |
<p>Abstract</p> <p>Background</p> <p>The Bladder cooling reflex (BCR) i.e. uninhibited detrusor contractions evoked by intravesical instillation of cold saline, is a segmental reflex believed to be triggered by menthol sensitive cold receptors in the bladder wall, with the afferent signals transmitted by C fibres. The BCR is a neonatal reflex that becomes suppressed by descending signals from higher centres at approximately the time when the child gains full voluntary control of voiding. It re-emerges in adults with neurogenic detrusor overactivity as a consequence of loss of central descending inhibition, resulting from conditions such as spinal cord injury or multiple sclerosis. We have recently shown an increase of nerve fibres expressing the cool and menthol receptor TRPM8 in both overactive (IDO) and painful bladder syndrome (PBS), but its functional significance is unknown. We have therefore studied the bladder cooling reflex and associated sensory symptoms in patients with PBS and overactivity disorders.</p> <p>Methods</p> <p>The BCR, elicited by ice water test (IWT) was performed in patients with painful bladder syndrome (PBS, n = 17), idiopathic detrusor overactivity (IDO, n = 22), neurogenic detrusor overactivity (NDO, n = 4) and stress urinary incontinence (as controls, n = 21). The IWT was performed by intravesical instillation of cold saline (0 – 4°C). A positive IWT was defined as presence of uninhibited detrusor contraction evoked by cold saline, associated with urgency or with fluid expulsion. Patients were asked to report and rate any pain and cold sensation during the test.</p> <p>Results</p> <p>A positive IWT was observed in IDO (6/22, 27.3%) and NDO (4/4, 100%) patients, but was negative in all control and PBS patients. Thirteen (76.5%) PBS patients reported pain during the IWT, with significantly higher pain scores during ice water instillation compared to the baseline (P = 0.0002), or equivalent amount of bladder filling (100 mls) with saline at room temperature (P = 0.015). None of the control or overactive (NDO/IDO) patients reported any pain during the IWT.</p> <p>Conclusion</p> <p>The BCR in DO may reflect loss of central inhibition, which appears necessary to elicit this reflex; the pain elicited in PBS suggests afferent sensitisation, hence sensory symptoms are evoked but not reflex detrusor contractions. The ice water test may be a useful and simple marker for clinical trials in PBS, particularly for novel selective TRPM8 antagonists.</p> |
url |
http://www.biomedcentral.com/1471-2490/6/31 |
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