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Autonomic Dysreflexia in Neuro-urological Practice

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Handbook of Neurourology

Abstract

Autonomic dysreflexia (AD), defined as a sudden increase in systolic blood pressure (SBP), is commonly seen in individuals with spinal cord injury (SCI) at the spinal segment thoracic six (T6) or above as well as in multiple sclerosis with spinal lesions at T6 or above. AD can be elicited by either noxious or innocuous stimuli from below the level of injury. The lower urinary tract (LUT) plays a crucial role as the majority of AD episodes is related to LUT stimulation, such as urinary bladder distention, urinary catheters blockage, or urinary tract infection. Since AD can easily occur more than 40 times a day, if misdiagnosed or poorly managed, disastrous cerebro- and cardiovascular complications can arise, such as myocardial infarction, cerebral hemorrhage, seizures, and even death. Urological procedures, such as urodynamic studies (UDS), cystoscopy, and penile vibrostimulation (PVS), are well-known triggers of AD. Regarding the former, neurogenic detrusor overactivity and the neurological level of SCI were found to be independent predictors, with the highest odds for individuals with cervical SCI to experience AD during UDS. During cystoscopy, SBP responses were reported to be greater than during UDS and more pronounced in those with more than two years after SCI. Furthermore, AD during cystoscopy was only observed in individuals with SCI at T6 or above. During PVS, dangerously high increases in SBP of more than 250 mmHg and a high prevalence of arrhythmias have been reported, thus placing a tremendous health burden on male individuals who wish to father children. Considering all potential AD-related health risks, it is crucial to survey patients using cardiovascular monitoring during urological procedures. Particular emphasis should be given to individuals with cervical lesions due to their impaired or abolished sympathetic control of the heart, as they are at the highest risk for AD and associated arrhythmias.

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Authors and Affiliations

  1. International Collaboration on Repair Discoveries (ICORD), Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada

    Andrei V. Krassioukov

  2. Division of Physical Medicine and Rehabilitation, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada

    Andrei V. Krassioukov

  3. G.F. Strong Rehabilitation Centre, Vancouver, BC, Canada

    Andrei V. Krassioukov

  4. Department of Urology, University Hospital Basel, University of Basel, Basel, Switzerland

    Matthias Walter

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  1. Andrei V. Krassioukov
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  2. Matthias Walter
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Correspondence to Andrei V. Krassioukov .

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  1. Department of Urology, China Rehabiliation Research Center Capital Medical University, Beijing, China

    Limin Liao

  2. Department of Urology, Medical University Innsbruck, University Hospital, Innsbruck, Austria

    Helmut Madersbacher

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Krassioukov, A.V., Walter, M. (2023). Autonomic Dysreflexia in Neuro-urological Practice. In: Liao, L., Madersbacher, H. (eds) Handbook of Neurourology. Springer, Singapore. https://doi.org/10.1007/978-981-16-7939-1_81-1

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