Use of the ice water test as an early predictor of recovery of erectile function in patients with spinal cord injury

Abstract

Study design: Retrospective, cross-sectional. Objectives: To determine the capacity of the ice water test (IWT) to predict erectile function during the early phase of spinal cord injury (SCI). Setting: France. Methods: This was a retrospective, cross-sectional study. Data from patients with SCI were included if they presented with neurogenic shock causing erectile dysfunction AND detrusor underactivity, and had undergone the following evaluations during the first 6 months post SCI (E1), and again at least 2 years later (E2): a complete neurological examination, urodynamic evaluation with the IWT, and evaluation by the Erection Hardness Score (EHS, from 0 to 4). Patients with cauda equina syndromes were excluded. Results: Data from 62 patients with SCI were included, 37 with a positive IWT and 25 with a negative IWT. E1 was performed at 3.2 months ± 1.9, and E2 at 2.0 years ± 2.9 post SCI. At E2, 95% of patients with an initial positive IWT had reliable erections (EHS 3 or 4), compared with 0% of patients with a negative IWT. Neurogenic detrusor overactivity was found in 89% of patients with a positive IWT compared with 8% with a negative IWT. The IWT had a good sensitivity and negative predictive value: 100% for erectile function, and respectively 94 and 92% for bladder function. Conclusion: The IWT is a reliable and predictive test of erectile potential in patients with sacral and suprasacral SCI.