Autonomic dysreflexia and repeatability of cardiovascular changes during same session repeat urodynamic investigation in women with spinal cord injury

Walter, Matthias; Knüpfer, Stephanie C.; Leitner, Lorenz; Mehnert, Ulrich; Schubert, Martin; Curt, Armin; Kessler, Thomas M.

doi:10.1007/s00345-015-1589-1

Cited by 18 publications

(12 citation statements)

References 32 publications

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“…For all other urodynamic parameters assessed, however, there were wide 95% limits of agreement for differences in the parameters, indicating poor repeatability. These findings are very similar to the results in patients with neurogenic LUTD [ 24 , 26 ] and highlight the importance of same session repeat UDI for clinical decision making.…”

Section: Discussionsupporting

confidence: 88%

Urodynamic Investigation: A Valid Tool to Define Normal Lower Urinary Tract Function?

et al. 2016

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ObjectivesTo evaluate whether urodynamic investigation (UDI), the gold standard to assess refractory lower urinary tract symptoms (LUTS), is appropriate to select healthy volunteers with apparent normal lower urinary tract function as control subjects for comparative studies.Subjects and Methods42 healthy subjects (22 women, mean age 32±10 years; 20 men, mean age 37±12 years) without LUTS were included into this prospective single-centre cohort study. All subjects recorded a 3-day bladder diary, completed validated questionnaires regarding LUTS, and underwent neuro-urological assessment as well as free uroflowmetry. Same session repeat UDI was performed according to “Good Urodynamic Practice” recommended by the International Continence Society, but using an air-charged instead of a water-filled catheter, and evaluated by a blinded investigator.ResultsAll 3-day bladder diaries, LUTS questionnaires, neuro-urological assessments and free uroflowmetries were within normal limits. Overall (either during the first or second UDI), same session repeat UDI revealed pathological findings in 71% (30/42): Detrusor overactivity was detected in 14% (3/22) and 30% (6/20), post void residual >100mL in 14% (3/22) and 25% (5/20), bladder outlet obstruction in 9% (2/22) and 20% (4/20) and detrusor sphincter dyssynergia in 77% (17/22) and 65% (13/20) of our women and men, respectively.Repeatability of detrusor overactivity (κ = 0.78, 95% CI: 0.54–1.02) and detrusor sphincter dyssynergia (κ = 0.77, 95% CI: 0.55–0.98) showed substantial agreement between both UDIs. All other assessed urodynamic parameters had wide 95% limits of agreement for differences in the parameters indicating poor repeatability.ConclusionsMore than 70% of our healthy subjects showed pathological urodynamic findings. Although UDI is the gold standard to assess refractory LUTS, it seems not to be applicable in healthy subjects to define normal lower urinary tract function. Therefore, we do not recommend using UDI to select healthy control subjects.

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Section: Discussionsupporting

confidence: 88%

Urodynamic Investigation: A Valid Tool to Define Normal Lower Urinary Tract Function?

et al. 2016

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“…The International Standards to document remaining Autonomic Function after Spinal Cord Injury (ISAFSCI) 17 recommends the diagnostic criteria for AD as a SBP increase of 420 mm Hg from baseline. Only two previous studies 14,15 used the same criteria; however, the study by Huang et al 14 did not clarify SBP, DBP and heart rate (HR) changes in the AD subgroup but only demonstrated a change in a combination of these CV parameters in all individuals with and without AD. Therefore, it is difficult to obtain data for evaluation of the severity of AD in this study.…”

Section: Introductionmentioning

confidence: 99%

“…Linsenmeyer et al 12 found urodynamic examination to be an excellent way to detect whether individuals with SCI are prone to asymptomatic AD. Previous studies revealed incidences of AD during urodynamics, [11][12][13][14][15][16] but the diagnostic criteria varied among these studies. Some studies 12,13 used maximal SBP and DBP as criteria, whereas others 11,[14][15][16] just used SBP change.…”

Section: Introductionmentioning

confidence: 99%

“…Previous studies revealed incidences of AD during urodynamics, [11][12][13][14][15][16] but the diagnostic criteria varied among these studies. Some studies 12,13 used maximal SBP and DBP as criteria, whereas others 11,[14][15][16] just used SBP change. The International Standards to document remaining Autonomic Function after Spinal Cord Injury (ISAFSCI) 17 recommends the diagnostic criteria for AD as a SBP increase of 420 mm Hg from baseline.…”

Section: Introductionmentioning

confidence: 99%

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Cardiovascular response during urodynamics in individuals with spinal cord injury

Liu

Biering‐Sørensen

et al. 2016

Spinal Cord

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“…Urodynamic investigation (UDI) is the gold standard to assess neurogenic lower urinary tract dysfunction (NLUTD) in patients with SCI [ 3 , 4 ], but it may induce AD [ 15 , 16 ]. Considering that it is currently not possible to know in advance which patient will experience AD during UDI and, of those with AD, to what extent the systolic blood pressure (SBP) will increase, we aimed to determine the overall incidence and predictors of AD during UDI.…”

Section: Introductionmentioning

confidence: 99%

Prediction of autonomic dysreflexia during urodynamics: a prospective cohort study

Walter

Knüpfer

Cragg

et al. 2018

BMC Med

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BackgroundAutonomic dysreflexia is a severe and potentially life-threatening condition in patients with spinal cord injury, as it can lead to myocardial ischemia, brain hemorrhage, or even death. Urodynamic investigation is the gold standard to assess neurogenic lower urinary tract dysfunction due to spinal cord injury and reveal crucial pathological findings, such as neurogenic detrusor overactivity. However, neurogenic detrusor overactivity and urodynamic investigation are known to be leading triggers of autonomic dysreflexia. Therefore, we aimed to determine predictors of autonomic dysreflexia in individuals with spinal cord injury during urodynamic investigation.MethodsThis prospective cohort study included 300 patients with spinal cord injuries and complete datasets of continuous non-invasive cardiovascular monitoring, recorded during same session repeat urodynamic investigation. We used logistic regression to reveal predictors of autonomic dysreflexia during urodynamic investigation.ResultsWe found that level of injury and presence of neurogenic detrusor overactivity were the only two independent significant predictors for autonomic dysreflexia during urodynamic investigation. A lesion at spinal segment T6 or above (odds ratio (OR) 5.5, 95% CI 3.2–9.4) compared to one at T7 or below, and presence of neurogenic detrusor overactivity (OR 2.7, 95% confidence interval (CI) 1.4–4.9) were associated with a significant increased odds of autonomic dysreflexia during urodynamic investigation. Both odds persisted after adjustment for age, sex, and completeness and stage of injury (adjusted OR (AOR) 6.6, 95% CI 3.8–11.7, and AOR 2.2, 95% CI 1.1–4.5, respectively). Further stratification by lesion level showed level-dependent significantly increased adjusted odds of autonomic dysreflexia, i.e., from C1–C4 (AOR 16.2, 95% CI 5.9–57.9) to T4–T6 (AOR 2.6, 95% CI 1.3–5.2), compared to lesions at T7 or below.ConclusionsIn patients with neurogenic lower urinary tract dysfunction due to spinal cord injury, autonomic dysreflexia is independently predicted by lesion level and presence of neurogenic detrusor overactivity. Considering the health risks associated with autonomic dysreflexia, such as seizures, stroke, retinal bleeding, or even death, we recommend both continuous cardiovascular monitoring during urodynamic investigation in all spinal cord-injured patients with emphasis on those with cervical lesions, and appropriate neurogenic detrusor overactivity treatment to reduce the probability of potentially life-threatening complications.Trial registrationClinicalTrials.gov, NCT01293110.Electronic supplementary materialThe online version of this article (10.1186/s12916-018-1040-8) contains supplementary material, which is available to authorized users.

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Autonomic dysreflexia and repeatability of cardiovascular changes during same session repeat urodynamic investigation in women with spinal cord injury

Abstract: In all women with NLUTD due to suprasacral SCI, we strongly recommend continuous cardiovascular monitoring during UDI and repeat measurements considering the high incidence of AD, the relevant risks involved with sudden hypertension and the poor repeatability of cardiovascular monitoring.

Cited by 18 publications

References 32 publications

Urodynamic Investigation: A Valid Tool to Define Normal Lower Urinary Tract Function?

Urodynamic Investigation: A Valid Tool to Define Normal Lower Urinary Tract Function?

Cardiovascular response during urodynamics in individuals with spinal cord injury

Prediction of autonomic dysreflexia during urodynamics: a prospective cohort study

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