Autonomic Dysreflexia Severity between Urodynamics and Cystoscopy in Patients with Spinal Cord Injury above T6

Heyi Zhen,Hui Chen,Tianhai Huang,Qiuling Liu,Qingqing Li,Maping Huang,Xiaoyi Yang

doi:10.4236/ijcm.2021.128031

Abstract

Objective: The objective is to evaluate autonomic dysreflexia (AD) severity between urodynamics and cystoscopy in patients with spinal cord injury (SCI) above thoracic 6 (T6). Design: It is a cross-sectional survey. Subject and methods: The study was carried out in 22 patients with SCI above T6 who underwent both procedures of urodynamics and cystoscopy; all patients developed episodes of AD. The systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured and recorded at the beginning and during the various stages of the two examinations. AD was defined as a rise in SBP above 20 mm Hg. Results: There was no significant difference in SBP and DBP at baseline before urodynamics and cystoscopy. Both urodynamics and cystoscopy triggered episodes of AD. The volume of water instilled during cystoscopy was typically standard and smaller (150 mL) in comparison with urodynamics, where volume varied depending on cystometric bladder capacity (the mean bladder volume in our study was 234.86 ± 139.06 mL). The SBP was significantly different between cystoscopy and urodynamics (49.23 ± 23.07 mm Hg and 35.14 ± 15.75 mm Hg, respectively; P = 0.023). Conclusions: Although bladder distension during cystoscopy was less than that in urodynamics, the severity of AD was more pronounced during cystoscopy. It is recommended that monitoring of cardiovascular parameters during these procedures should be routinely performed.

Highlights

Spinal cord injury (SCI) is a significant cause of morbidity and mortality in developed nations, with a global annual incidence of 1:25,000 [1] [2]
The volume of water instilled during cystoscopy was typically standard and smaller (150 mL) in comparison with urodynamics, where volume varied depending on cystometric bladder capacity
Conclusions: bladder distension during cystoscopy was less than that in urodynamics, the severity of autonomic dysreflexia (AD) was more pronounced during cystoscopy

Summary

Introduction

Spinal cord injury (SCI) is a significant cause of morbidity and mortality in developed nations, with a global annual incidence of 1:25,000 [1] [2]. AD is clinically defined as an elevation in systolic blood pressure (SBP) ≥ 20 mm Hg from baseline in response to noxious or innocuous stimuli below injury level [3]. It is an acute disease with symptoms ranging from mild, such as headache, sweating, hot flashes, piloerection, and anxiety, to severe [4] [5] [6] [7] [8], such as arrhythmia, including atrial fibrillation, and high SBP above 300 mmHg, which may lead to cerebral hemorrhage and to convulsions and death [9] [10] [11]. We evaluate the severity of AD in individuals with SCI at or above thoracic 6 (T6) level performed both urological procedures of urodynamics and cystoscopy

Methods

Results

Conclusion