Autonomic hyperreflexia during cystoscopy in patients with high spinal cord injuries

Abstract

Abstract. Cystoscopic procedures were performed on 102 patients with histories of traumatic spinal cord lesion; 57 patients had sensorimotor levels above T7, and the remaining 45 patients had levels below T7. In 40 of the 57 patients (70 per cent) with levels above T7, signs and symptoms of autonomic hyperreflexia were seen during bladder distension and cystoscopy; the remaining 17 of these patients (30 per cent) did not have this response. No autonomic hyperreflexia was seen during cystoscopy in any of the 45 patients with sensorimotor levels below T7.

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

“…[3][4][5][6][7][8] Our study presents novel information on comparison of the CV responses of the same group of individuals with SCI during two consecutive urological procedures: urodynamics and cystoscopy. The results of our study indicate that as a result of AD, the increase in SBP during cystoscopy was significantly higher (67.1±33.8 mm Hg) than during urodynamics (51.8 ± 21.8 mm Hg, P ¼ 0.039).…”

“…[3][4][5][6][7][8] Typically, AD is triggered by noxious or non-noxious stimuli below the level of injury. In the majority of situations for individuals with SCI, these triggers originate within the urinary bladder.…”

“…3 Previously, numerous studies using different groups of individuals with SCI examined CV responses either during urodynamic [3][4][5][6] or cystoscopic examination. 7,8 These two procedures both involve urinary bladder distension. However, cystoscopy includes greater stimulation of the urethra and bladder neck afferents during the procedure through urethral/prostate/ internal sphincter passage and dilation, which could then provide more intense afferent stimulation to the spinal cord and trigger more pronounced episodes of AD.…”

Autonomic dysreflexia in response to pudendal nerve stimulation

“…AD frequently occurs to distensions of hollow organs such as bladder or bowel. However, a variety of other triggering factors such as urinary tract infection, transurethral catheterization, detrusor-sphincter dyssynergia, 16 cystoscopy 17 and bladder percussion 18 have also been observed. In a Swedish population, seven out of 48 chronic SCI patients reported on AD in response to sexual activity including ejaculation, vibrator stimulation or sexual intercourse.…”

Latest Approaches for the Treatment of Spasticity and Autonomic Dysreflexia in Chronic Spinal Cord Injury

“…One of the most common triggers of hypertensive autonomic dysreflexia is the distension of pelvic viscera (bladder and bowel) [6][7][8]. The consequent afferent barrage into the lumbosacral spinal cord results in massive sympathetic discharge below the level of the lesion, resulting in vasoconstriction of the muscular, splanchnic, and cutaneous vascular beds.…”