Autonomic dysreflexia severity during urodynamics and cystoscopy in individuals with spinal cord injury

• Published in: Spinal cord 2013-11, Vol.51 (11), p.863-867
• Main Authors: Liu, N, Fougere, R, Zhou, M-W, Nigro, M K, Krassioukov, A V
• Format: Article
• Language: English
• Subjects: 631/378/1689; 692/699/375/1824; 692/700/1421/164; Adult; Anatomy; Autonomic Dysreflexia - diagnosis; Autonomic Dysreflexia - physiopathology; Biomedical and Life Sciences; Biomedicine; Blood Pressure - physiology; Cystoscopy - adverse effects; Cystoscopy - methods; Female; Heart Rate - physiology; Human Physiology; Humans; Male; Middle Aged; Neurochemistry; Neuropsychology; Neurosciences; original-article; Retrospective Studies; Spinal Cord Injuries - complications; Spinal Cord Injuries - physiopathology; Urinary Bladder - physiopathology; Urodynamics - physiology; Young Adult
• ISSN: 1362-4393; 1476-5624
• DOI: 10.1038/sc.2013.113

Study Design: Retrospective chart review. Objective: To compare autonomic dysreflexia (AD) severity during urodynamics and cystoscopy in individuals with spinal cord injury (SCI). Setting: Outpatient urological clinic. Methods: Demographic and clinical data were collected from charts of individuals with SCI who had blood pressure (BP) monitoring during urological procedures. Cardiovascular parameters were collected at baseline and during the various stages of two examinations. Results: A total of 21 SCI individuals (mean age 49.4 years) who underwent both procedures developed episodes of AD. The majority of individuals had cervical SCI (85.7%). The median duration of injury was 183 months (ranging from 3 to 530 months). There was statistically more of an increase ( P =0.039) in systolic BP during cystoscopy (67.1±33.8 mm Hg) in comparison with urodynamics (51.8±21.8 mm Hg). The BP response during episodes of AD was more pronounced in individuals with more than 2 years post SCI than with less than 2 years post SCI during both urodynamics and cystoscopy ( P =0.047 and P =0.010, respectively). Conclusion: Even though cystoscopy filled the bladder to lesser volumes than did urodynamics (150 ml vs 500 ml), during cystoscopy the individuals developed greater changes in systolic BP, indicating that stimulation of the urethra/prostate/internal sphincter region probably is a more potent stimulus of AD than just the filling of the bladder. The severity of AD also increased with time post SCI during both procedures. Considering the high incidence of silent episodes of AD during the urological procedures, it is recommended that monitoring of cardiovascular parameters during these procedures be routinely performed.