Læknablaðið - 15.11.1993, Blaðsíða 46

376
LÆKNABLAÐIÐ
nor the volume was critical for the outcome
of the test provided the bladder wall was
sufficiently cooled. The BCT, performed in
50 neurologically intact infants and children,
was positive during the first 4 years of life but
typically negative in children over 5.
A large retrospectively study of 557 patients
showed that all persons with lower motor
neuron lesions and pure stress incontinence
had a negative BCT while 97% and 91% of
those with complete and incomplete upper
motor neuron lesions, respectively, had a
positive test. About 75% of the patients with
overactive bladder associated with multiple
sclerosis, Parkinson’s disease and sequelae
to cerebrovascular insult had a positive BCT.
A new functional subdivision of overactive
bladders, based on cystometry and clinical
findings, is presented. Of 501 patients
with overactive bladder, the largest group of
patients had signs and symptoms consistent
with the diagnosis »uninhibited overactive
bladder« (UOB), characterised by impaired
perception of bladder fullness, loss of
voluntary inhibition of micturition and a
positive BCT.
Concliisions: Man has a bladder cooling
reflex with the same characteristics as that
of laboratory animals. The reflex is positive
in neurologically normal infants and young
children. During normal development it
becomes suppressed by descending signals
from higher centres and is typically negative
in older children and adults. The bladder
cooling reflex may be unmasked by specific
lesions of the control pathways. The BCT is
helpful in differentiating between subtypes of
overactive bladders.