Autonomic response during bladder hydrodistention reflects the severity of symptoms in patients with bladder pain syndrome/interstitial cystitis

Abstract

Under general anesthesia, exaggerated autonomic responses to bladder hydrodistention were demonstrated in BPS/IC patients, which reflected the severity of symptoms. These results support the hypothesis of altered activity of autonomic system in BPS/IC. Neurourol. Urodynam. 36:677-682, 2017. © 2016 Wiley Periodicals, Inc.

Autonomic responses during bladder hydrodistention under general versus spinal anaesthesia in patients with interstitial cystitis/bladder pain syndrome: a randomized clinical trial

“…A previous retrospective study reported a ΔSBP in patients with IC/BPS of 56.26 ± 30.38 mmHg under general anaesthesia 10 . We considered a mean difference in ΔSBP between the two anaesthesia groups of 30 mmHg or more statistically significant.…”

“…In a retrospective study with a limited number of patients, autonomic responses during bladder hydrodistention were greater in patients under general anaesthesia than in those under spinal anaesthesia 10 . Spinal anaesthesia can block all sensory, motor, and autonomic nerve transmission and 11 lower serum concentration of catecholamines 12 .…”

Small Fiber Polyneuropathy May Be a Nexus Between Autonomic Nervous System Dysregulation and Pain in Interstitial Cystitis/Bladder Pain Syndrome

“…Abnormal findings include an increased sympathetic bladder innervation ( 11 ), non-specific altered NANC bladder innervation ( 9 , 11 , 13 ), increased urinary secretion of norepinephrine ( 16 , 17 , 51 ), as well as increased serum norepinephrine ( 17 , 51 ). Furthermore, there are non-specific signs of increased systemic sympathetic tone through an increased resting heart rate ( 25 – 27 ) and blood pressure ( 26 ), and an increased vesicovascular response to bladder distension ( 28 , 29 ). HRV testing, however, suggests decreased cardiac parasympathetic tone ( 26 , 31 ).…”

“…An exaggerated response can be inferred to indicate increased sympathetic outflow. Those undergoing spinal anesthesia did not experience these changes, providing further evidence that this is mediated through sympathetic loops in the spinal cord ( 29 ). It is also notable that at baseline prior to their operation, these patients did not have differences in HR or BP measurements compared to controls.…”

“…These changes in vascular autonomic function are further evidenced by the fact that while undergoing therapeutic hydrodistention, patients with IC/BPS are found to have significant elevations in blood pressure and heart rate that are not found in control patients ( 28 , 29 ). This is likely an amplification of the known physiologic vesicovascular response wherein filling of the bladder induces a sympathetic reflex loop that increases heart rate and blood pressure ( 30 ).…”