Cardiovascular response during urodynamics in individuals with spinal cord injury

Liu, Nan; Mw, Zhou; Biering‐Sørensen, Fin; Krassioukov, Andrei V.

doi:10.1038/sc.2016.110

Cited by 15 publications

(10 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In line with the literature [ 37 ], our AD patients with an AIS A lesion demonstrated a significantly greater decrease in HR than those with an AIS B–D lesion, indicating that the greater the extent of the injury, i.e., the fewer efferent fibers are spared to uphold central sympathetic control of the heart, the greater the influence on HR by the parasympathetic nervous system. In contrast to our observation, Giannantoni et al [ 27 ] reported that AD did not correlate with the completeness of a lesion.…”

Section: Discussionsupporting

confidence: 89%

Prediction of autonomic dysreflexia during urodynamics: a prospective cohort study

Walter

Knüpfer

Cragg

et al. 2018

BMC Med

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionsupporting

confidence: 89%

Prediction of autonomic dysreflexia during urodynamics: a prospective cohort study

Walter

Knüpfer

Cragg

et al. 2018

BMC Med

View full text Add to dashboard Cite

show abstract

“…Table 6 displayed the incidence of autonomic dysfunction of the patients with dysuria after high level SCI was very high (about 79.17%, adding B and C), most of them were hyperactivity (62.50%), and a few were hypoactivity (16.67%). NDSD [8] of group B and C was very high, that of high abdominal pressure of group B, C (53.33%, 87.50%) was evidently more quantity than that of group A (25.00%), the ratio of bladder disappearance of group B, C (30.00%, 25.00%) was fewer than that of group A (50.00%). From Table 8, compared with the baseline, it can be demonstrated that the values of SBP and DBP of a typical case at he time of stopping filling increased more than 20 mmHg.…”

Section: Resultsmentioning

confidence: 84%

Clinical Study on Evaluation of Autonomic Nervous Dysfunction Based on Imaging Urodynamic Examination with Slow Filling and Synchronous Blood Pressure Monitoring in the Patients with Cervicothoracic Spinal Cord Injury

Li¹,

Chen²,

Xiao³

et al. 2021

OJU

View full text Add to dashboard Cite

“…AD is an abnormal autonomic reflex responding to nociceptive stimuli below the level of injury, which develops in patients with high-level SCI (usually above T6). 77,78 A remarkable rise in blood pressure during AD sometimes leads to serious complications, such as intracranial hemorrhage and lethal arrhythmias. 77 Physicians should remove the causes of stimuli as soon as possible and deal with the hypertensive crisis (LoE 5, GoR B).…”

Section: Admentioning

confidence: 99%

Clinical guidelines for the diagnosis and treatment of lower urinary tract dysfunction in patients with spinal cord injury

et al. 2020

View full text Add to dashboard Cite

The present article is an abridged English translation of the Japanese clinical guidelines for the diagnosis and treatment of lower urinary tract dysfunction in patients with spinal cord injury updated as of July 2019. The patients are adult spinal cord injured patients with lower urinary tract dysfunction; special consideration of pediatric and elderly populations is presented separately. The target audience is healthcare providers who are engaged in the medical care of patients with spinal cord injury. The mandatory assessment includes medical history, physical examination, frequency‐volume chart, urinalysis, blood chemistry, transabdominal ultrasonography, measurement of post‐void residual urine, uroflowmetry and video‐urodynamic study. Optional assessments include questionnaires on the quality of life, renal scintigraphy and cystourethroscopy. The presence or absence of risk factors for renal damage and symptomatic urinary tract infection affects urinary management, as well as pharmacological treatments. Further treatment is recommended if the maximum conservative treatment fails to improve or prevent renal damage and symptomatic urinary tract infection. In addition, management of urinary incontinence should be considered individually in patients with risk factors for urinary incontinence and decreased quality of life.

show abstract

Cardiovascular response during urodynamics in individuals with spinal cord injury

Abstract: Individuals with cervical SCI, DSD, poor bladder compliance or >2 years after SCI were associated with a higher possibility of developing AD during urodynamics. Furthermore, AD was more severe in complete (AIS A) individuals and was exacerbated with time after injury.

Cited by 15 publications

References 25 publications

Prediction of autonomic dysreflexia during urodynamics: a prospective cohort study

Prediction of autonomic dysreflexia during urodynamics: a prospective cohort study

Clinical Study on Evaluation of Autonomic Nervous Dysfunction Based on Imaging Urodynamic Examination with Slow Filling and Synchronous Blood Pressure Monitoring in the Patients with Cervicothoracic Spinal Cord Injury

Clinical guidelines for the diagnosis and treatment of lower urinary tract dysfunction in patients with spinal cord injury

Contact Info

Product

Resources

About