PD36-04 AUTONOMIC DYSREFLEXIA: WHAT VARIABLES ARE ASSOCIATED WITH WORSENING SYMPTOMS IN SPINAL CORD INJURED PEOPLE?

Abstract

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Neurogenic Voiding Dysfunction (PD36)1 Sep 2021PD36-04 AUTONOMIC DYSREFLEXIA: WHAT VARIABLES ARE ASSOCIATED WITH WORSENING SYMPTOMS IN SPINAL CORD INJURED PEOPLE? John Stoffel, Rita Shehirian, Sara Lenherr, Sean Elliott, Diana O'Dell, Jeremy Myers, and Blayne Welk John StoffelJohn Stoffel More articles by this author , Rita ShehirianRita Shehirian More articles by this author , Sara LenherrSara Lenherr More articles by this author , Sean ElliottSean Elliott More articles by this author , Diana O'DellDiana O'Dell More articles by this author , Jeremy MyersJeremy Myers More articles by this author , and Blayne WelkBlayne Welk More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002040.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Autonomic dysreflexia (AD) can impact both the safety and quality of life of spinal cord injured people (SCI). We investigated whether bladder, bowel or pain symptoms were associated with worsening AD symptoms. METHODS: The Neurogenic Bladder Spinal Cord Injury registry prospectively enrolled SCI people in an observational study between 1/1/2016 – 6/30/2017. People self-reported demographic, clinical, and injury information. Quality of life was assessed with Neurogenic Bowel Dysfunction (NBD), Neurogenic Bladder Symptom Score (NBSS), and SCI SF-12 questionnaires. Chronic pain was reported as a dichotomous (y/n) variable. The severity of AD was assessed from a validated AD following SCI (ADFSCI) instrument and included domains of exercise, sexual activity, bladder function, bowel function, provoked and unprovoked activities. Total ADFSCI score ranged from 0 – 24. Bladder management was defined as surgical reconstruction (augment/diversion), indwelling catheter (suprapubic/urethral), any clean intermittent catheterization (CIC), or voiding. Univariate analysis and a logistic regression model were used to determine associations between variables and ADFSCI score. RESULTS: The registry enrolled 1470 people, of which 843 (57%) had paraplegia and 894 (60%) were men. The median age was 45 years and median time from injury was 11 years. Bladder management was reported as CIC in 754 (51%), indwelling catheter in 271 (18%), surgery in 195 (13%) and voiding in 259 (18%). On univariate analysis, higher ADFSCI scores were reported among people with complete (3.91 vs 3.37, p = 0.02) and cervical/thoracic injures (3.83 CT vs 1.53 LS, p<0.0001), chronic pain (3.89 vs 2.86, p=0.0004), and multiple UTI’s (4.39 vs 2.66, p<0.0001). Rising ADFSCI score correlated with positively with increasing NBD score (r=0.243, p <0.0001) and negatively with age (r=-0.189, p <0.0001). Patients with indwelling catheters (5.25) or reconstructive surgery (4.48) had higher ADFSCI scores than CIC (3.00) and voiding (2.85) (p<0.0001). Multivariable analysis showed that level of injury, age, NBD score, and bladder management remained significantly associated with rising ADFSCI score. CONCLUSIONS: There were multiple variables associated with increased autonomic dysreflexia symptoms in this SCI cohort including level of injury, younger age, and worsening bowel symptoms. From a urologic standpoint, people with an augment/diversion or bladder managed with indwelling catheter had more AD symptoms compared to CIC or voiding. Source of Funding: PCORI © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e596-e596 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information John Stoffel More articles by this author Rita Shehirian More articles by this author Sara Lenherr More articles by this author Sean Elliott More articles by this author Diana O'Dell More articles by this author Jeremy Myers More articles by this author Blayne Welk More articles by this author Expand All Advertisement Loading ...