Abstract
Study Design:
Retrospective chart review.
Objective:
To compare autonomic dysreflexia (AD) severity during urodynamics and cystoscopy in individuals with spinal cord injury (SCI).
Setting:
Outpatient urological clinic.
Methods:
Demographic and clinical data were collected from charts of individuals with SCI who had blood pressure (BP) monitoring during urological procedures. Cardiovascular parameters were collected at baseline and during the various stages of two examinations.
Results:
A total of 21 SCI individuals (mean age 49.4 years) who underwent both procedures developed episodes of AD. The majority of individuals had cervical SCI (85.7%). The median duration of injury was 183 months (ranging from 3 to 530 months). There was statistically more of an increase (P=0.039) in systolic BP during cystoscopy (67.1±33.8 mm Hg) in comparison with urodynamics (51.8±21.8 mm Hg). The BP response during episodes of AD was more pronounced in individuals with more than 2 years post SCI than with less than 2 years post SCI during both urodynamics and cystoscopy (P=0.047 and P=0.010, respectively).
Conclusion:
Even though cystoscopy filled the bladder to lesser volumes than did urodynamics (150 ml vs 500 ml), during cystoscopy the individuals developed greater changes in systolic BP, indicating that stimulation of the urethra/prostate/internal sphincter region probably is a more potent stimulus of AD than just the filling of the bladder. The severity of AD also increased with time post SCI during both procedures. Considering the high incidence of silent episodes of AD during the urological procedures, it is recommended that monitoring of cardiovascular parameters during these procedures be routinely performed.
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Acknowledgements
Dr Nan Liu is supported by a State scholarship from the China Scholarship Council to the Laboratory of Dr Krassioukov, International Collaboration on Research Discoveries (ICORD), University of British Columbia, Canada; Dr Andrei Krassioukov is supported by grants from the Canadian Heart and Stroke Foundation, Canadian Institute of Health Research, Canadian Foundation for Innovation, Rick Hansen Institute, Craig Neilsen Foundation and Christopher and Dana Reeve Foundation. We also acknowledge support from staff at the Blusson Spinal Cord Clinic during the preparation of this manuscript, Ms Teresa Lim and Ms Colleen McLean.
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Liu, N., Fougere, R., Zhou, MW. et al. Autonomic dysreflexia severity during urodynamics and cystoscopy in individuals with spinal cord injury. Spinal Cord 51, 863–867 (2013). https://doi.org/10.1038/sc.2013.113
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DOI: https://doi.org/10.1038/sc.2013.113
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