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Related Experiment Videos

Autonomic dysreflexia during urodynamics

A Giannantoni1, S M Di Stasi, G Scivoletto

  • 1IRCCS S. Lucia Rehabilitation Hospital, Department of Surgery/Urology, Tor Vergata University of Rome, Italy.

Spinal Cord
|December 16, 1998
PubMed
Summary
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Autonomic dysreflexia (AD) can occur during urodynamic evaluation in spinal cord injury patients. Bladder distension and contractions can trigger AD, even without symptoms, highlighting the need for careful monitoring.

Area of Science:

  • Urology
  • Neurology
  • Clinical Medicine

Background:

  • Autonomic dysreflexia (AD) is a potentially life-threatening condition in individuals with spinal cord injury (SCI) above T6.
  • It involves an exaggerated autonomic response to stimuli below the level of injury.
  • Urodynamic evaluation is a common procedure for SCI patients, but the risk of precipitating AD is a concern.

Purpose of the Study:

  • To determine the incidence of AD during cystometry in SCI patients.
  • To explore the relationship between AD and various clinical and urodynamic parameters.
  • To identify risk factors and triggers for AD during bladder assessment.

Main Methods:

  • Forty-eight patients with SCI above T6 underwent neurological and urological examinations.

Related Experiment Videos

  • Urodynamic evaluation was performed with concurrent monitoring of blood pressure, heart rate, and AD symptoms.
  • AD was defined as blood pressure exceeding 150/100 mmHg.

    • Main Results:

    • All patients exhibited significant blood pressure increases during urodynamics; 20 met the criteria for AD (seven asymptomatic).
    • AD was more prevalent in patients with cervical SCI (P=0.034).
    • No correlation was found between AD and other clinical factors like age, sex, disease duration, lesion completeness, detrusor activity, voiding status, or anticholinergic use.

    Conclusions:

    • Urodynamic evaluation can elicit sympathetic stimulation in SCI patients, manifesting as elevated blood pressure, even without overt AD symptoms.
    • Detrusor overactivity and bladder distension are identified triggers for AD during urodynamic testing.
    • Anticholinergic medication is insufficient to prevent bladder-initiated AD unless it achieves detrusor areflexia, emphasizing the risk posed by bladder distension.