Autonomic dysreflexia during cystolitholapaxy in patients with spinal cord injury

This study aims to explore the risk factors associated with autonomic dysreflexia (AD) reflex during cystolitholapaxy and increase the awareness of urologists on the dangerous reaction of AD in patients with spinal cord injury (SCI).

Data of 89 SCI patients with bladder stone who underwent cystolitholapaxy were retrospectively analyzed. Patients were divided into two groups according to the presence or absence of AD. Risk factors may associated with AD during the endoscopic procedure were analyzed by comparing clinical and operative features between the two groups.

Of the 89 patients, 31 (34.83%) developed AD during the procedure. The patients who developed AD had larger stones (4.58±1.26 cm vs. 3.75±1.15 cm, P<0.01), more stones (2.29±0.86 vs. 1.74±0.81, P<0.01), and greater injury (83.87% vs. 41.38%, above T6, P<0.01) than those who did not develop AD. The patients who developed AD suffered higher irrigation (83.55± 13.05 cm vs. 77.47±10.91 cm, P<0.05) and longer operation time (60.65±17.78 min vs. 49.31±14.31 min, P<0.01) than those who did not develop AD. The AD group also received local anesthetics to a larger extent compared with non-AD group, which more often had spinal anesthesia.

The patients who developed AD during the procedure had larger stones, more stone number, injury level more often above T6, higher hydraulic irrigation height, and longer operation time compared with the patients who did not develop AD. Urologists should pay extra care when performing cystolitholapaxy on individuals with these features.