Micturition syncope following intermittent catheterisation in a tetraplegic patient

Abstract

Study design: Case report. Objective: To describe a case of severe hypotension and occasional syncope following intermittent catheterisations in a tetraplegic patient. Setting: Department of Spinal Injuries, Berck, France. Case report: A 47-year-old man presenting with C7 ASIA B tetraplegia for 9 months, developed episodes of severe hypotension and occasional syncope following intermittent catheterisations. These episodes were observed in the minutes following the catheterisations performed in the sitting position, associating hypotension and bradycardia. He was on intermittent catheterisation, had a history of bladder hyper-reflexia with some episodes of symptomatic urinary tract infections, of mild autonomic dysreflexia (headache, sweating) on high bladder distension, of mild orthostatic hypotension, and of reactional depression to the trauma, treated with fluoxetine hydrochloride (Prozac s ). Results: The progressive removal of the fluoxetine hydrochloride (Prozac s ) led to disappearance of the syncope 1 week later. Mild hypotension after catheterisations still persisted though, but completely disappeared a few months later after further management of bladder hyper-reflexia with botulinum-A toxin injections into the detrusor. Conclusion: In spinal cord injury patients at risk of micturition syncope, care should be taken to achieve a gradual decrease in bladder volume, to control bladder hyper-reflexia and to avoid any medications with orthostatic hypotension's side effects.

Severe hypotension following urethral catheterization during general anesthesia in a patient with bladder cancer -A case report-

“…Micturition syncope can be an isolated symptom in healthy subjects, but it is frequently associated with other neurological causes, such as autonomic failure of primary (multiple system atrophy; MSA) or secondary (such as diabetes) etiology. In addition, it was reported that intermittent catheterization caused micturition syncope in a quadriplegic patient due to cervical spinal cord injury that was accompanied with autonomic dysreflexia [2,10]. …”

SARS-CoV-2 infection associated with micturition syncope

“…Micturition syncope can be caused by the vasovagal reflex or with the dysfunction of the blood pressure regulating mechanism (as in hypotension), which occurs before, during, or immediately after urination. It has been reported especially in male patients, associated with orthostatism, in healthy people, especially in the age group of 40 to 50 years, or in those with neurological disorders, [ 1 , 2 ] diabetes mellitus, spinal cord injuries, [ 3 ] patients that are on vasodilator medication or depression medication (selective serotonin reuptake inhibitors and tricyclic antidepressants), antipsychotics and levodopa.…”

“…As described in the literature, neoplastic diseases such as a paraganglioma of the urinary bladder [ 4 ] or intermittent urinary bladder catheterization in patients with neurological disorders can be associated with micturition syncope. [ 3 ] The occurrence of micturition syncope in the clinical course of SARS-CoV-2 infection in the 4 patients of different ages, with or without comorbidities, raises the issue of the association of micturition syncope with coronavirus infection.…”