Outcome of the bladder cooling test in children with neurogenic bladder dysfunction

Purpose: We evaluated the diagnostic use of the bladder cooling test in chi ldren with neurogenic bladder dysfunction. Materials and Methods: We performed 201 bladder cooling tests in 65 female and 43 male patients 5 days to 17 years old, including 70 with myelomeningo cele, 12 with high spinal lesions, 9 with sacral spinal lesions and 17 with encephalopathy of various types. At the end of routine cystometry we rapid ly infused body temperature saline to approximately a third of cystometric capacity, followed by the same volume of saline at 4 to 8C. The test was co nsidered positive when a detrusor contraction greater than 30 cm. water was evoked by the cold but not the warm infusion. Results: The bladder cooling test was positive in 31 children younger than 4 years, at which age it is normally positive. The test was negative in onl y 2 patients, indicating a complete lower motor neuron lesion. It was posit ive in 34 of the 57 children older than 6 years, at which age it should be negative. Thus, the positive bladder cooling test confirmed neurogenic blad der dysfunction. Four of the 20 children with a negative test voided normal ly, while the remainder had no voiding contractions, suggesting a nonfuncti onal spinal sacral reflex arch to the bladder. Conclusions: The bladder cooling test is a simple, reliable assessment that may serve to demonstrate a functional sacral reflex arch in young patients without voiding contractions or confirm a suspected lower motor neuron les ion. It may be used longitudinally to demonstrate changes in bladder functi on with growth.