Symptoms Of Autonomic Dysreflexia Research Articles

“Meet the patient” session: a strategy to teach medical students about autonomic dysfunction after spinal cord injury

Dysregulation of the autonomic nervous system is an important long-term consequence of spinal cord injury (SCI). Yet, there is a scarcity of teaching resources about this topic for preclinical medical students. Given the association of SCI sequelae with emergency complications and mortality, it is imperative to equip medical students with the ability to recognize them. We designed a “Meet the Patient” (MTP) session with the primary goal to enhance student learning about SCI sequelae by interacting with patients and listening to real-life stories. The session primarily focused on recognizing triggers and symptoms of autonomic dysreflexia (AD) and discussing the loss of bowel and bladder control, while providing opportunities to learn more about living with SCI from patients’ real-life experiences. During the MTP session, patients living with SCI discussed their experience with AD, neurogenic bowel and bladder, and spasticity, among other SCI sequelae. We evaluated the outcomes of the MTP session by assessing numerical performance in questions related to the session (post-session quiz and final exam) and students’ satisfaction (post-session survey) in two subsequent academic years. The numerical performance in SCI-questions was high for both academic years (and higher than national average for the final exam question), indicating adequate acquisition of knowledge. Satisfaction with the session was high, with most students indicating that the session helped them consolidate their knowledge about the topic.

Effect of neurogenic bowel dysfunction symptoms on quality of life after a spinal cord injury

BackgroundNeurogenic bowel dysfunction (NBD) is a common problem among people with spinal injury; management of bowel dysfunction and related problems are considered significant factors in daily life after injury. But despite the critical relevance of bowel dysfunction in the daily life of SCI survivors, there have been few published studies on the management of NBD. So, this study aimed to describe the bowel programmers utilized by people with SCI in China and the impact of bowel dysfunction on the quality of life (QoL).DesignA cross-sectional online survey.SettingRehabilitation Medicine Department of Wuhan’s Tongji Hospital.ParticipantsSCI patients who had been diagnosed with neurogenic bowel dysfunction and who were receiving regular medical monitoring at the rehabilitation medicine department were invited to participate in our study.Outcome measuresA neurogenic bowel dysfunction (NBD) score is a questionnaire developed to evaluate the severity of neurogenic bowel dysfunction. A Short Form-12 (SF-12) was designed to measure the quality of life in people with SCI. Demographic and medical status information was extracted from their medical records.ResultsThe two questionnaires were sent to 413 SCI patients. Two hundred ninety-four subjects (43.1 ± 14.5 years of age; men, 71.8%) responded. Most of the respondents performed their bowel movement daily 153 (52.0%), a defecation time was 31–60 min among 70 (23.8%) of them, 149 (50.7%) used medication (drops or liquid) to treat constipation, and 169 (57.5%) used digital stimulation more than once per week to boost the bowel evacuation. This study found a significant association between the QoL score and the time used for each defecation, autonomic dysreflexia (AD) symptoms, taking medication to treat fecal incontinence, using digital stimulation, having uncontrollable flatus and perianal skin problems.ConclusionManagement of bowel dysfunction is complex and associated with QoL in people with SCI. Items of the NBD questionnaire that greatly deteriorated the QoL were time in one defecation > 60 min, symptoms of AD during or before defecation, taking medication (drops or liquid), and using digital stimulation. Dealing with those problems can improve the life quality of spinal cord injury survivors.

Autonomic dysreflexia following spinal cord injury

Autonomic dysreflexia (AD) is one of the most common, yet most life-threatening, complication to occur following a spinal cord injury (SCI), at or above thoracic level six (T6). The main symptom of AD is a sudden and severe rise in blood pressure, which could cause death if untreated. Healthcare providers should be informed and familiar with the diagnosis and treatment of AD. It is important to note that most SCI patients, once discharged from rehabilitation hospitals, are managed at their own homes or a community rehabilitation setting, such as care, residential or nursing homes. Often, owing to the rapid onset and severity of the symptoms of AD, people with a SCI who develop AD are often admitted to the nearest local health facility, which may be staffed by healthcare professionals who have little or no knowledge or experience in managing AD. This article will offer very clear information regarding the causes, pathophysiology, symptoms and management of AD.

Autonomic Dysreflexia with Concurrent Orthostatic Hypotension: A Clinical Approach Dilemma

Background and aim: Autonomic dysreflexia (AD) commonly occurs in high cervical spinal cord injury (SCI) patients. However, concurrent orthostatic hypotension (OH) makes the management of this condition more difficult. This case report highlighted the complicated condition that creates a dilemma for clinicians to prioritise the management. Methods: A 26-year-old man presented with traumatic cervical SCI C4 ASIA B secondary to C3 – C5 vertebral body fracture underwent anterior corpectomy and fusion. He had frequent episodes of AD in the rehabilitation clinic, presenting with sweating, headache, and high blood pressure (BP) while he was in a wheelchair. No other precipitating factors were identified except for his chronic sacral and ischial wounds. These AD episodes also happened multiple times daily at home with intermittent presyncope attacks. He was given stat doses of Nifedipine during the clinic visits but was never prescribed antihypertensive as no proper BP monitoring was done at home. Nonpharmacological measures for OH were already established. The rehabilitation team educated him on a side-lying position to alleviate his AD symptoms and preventive strategies such as optimal pressure relief with wheelchair cushions and using the reclining function on his motorised wheelchair. Results: He had difficulty achieving independent mobility because he could not tolerate upright sitting without having AD and intermittent OH. Conclusion: OH as a precipitating factor for AD should be considered. The lowest possible dose of antispastic medications for optimum spasm control and consideration of mineralocorticoid drugs for OH management may be helpful. Antihypertensives are commonly used for prophylaxis of chronic recurrent AD. However, its usage may be limited in patients with OH. Prazosin may be an option as studies have shown that it did not excessively lower baseline BP. Pressure mapping and surgical intervention to facilitate chronic non-healing wound closure also should be considered. Chronic recurrent AD with intermittent OH remains a challenging condition in high SCI.

Cognitive functions in individuals with spinal cord injury: Do symptoms of autonomic dysreflexia or orthostatic hypotension have an effect?

Aims: This study aimed to compare the cognitive functions of individuals with spinal cord injury (SCI) and age- and education level-matched healthy controls, and to compare the cognitive functions between individuals with T6 or rostral and T6 caudal injuries. Materials and Methods: This prospective and cross sectional study included 50 individuals with SCI and 47 age- and education level-matched healthy controls. The SCI individuals were divided into two groups as those with T6 or rostral (n = 20) and T6 caudal (n = 30) injuries. All participants underwent the Addenbrook Cognitive Examination-Revised (ACE-R) test to assess memory, attention and orientation, language, and verbal fluency. Results: The memory, verbal fluency, and language subgroups of the ACE-R were significantly higher in the control group than in the SCI group. Compared with the control group, memory, verbal fluency, and language subscores were significantly reduced in individuals with T6 or rostral injury, and memory and verbal fluency were in individuals with T6 caudal injury. However, there was no significant difference in any of the ACE-R subscores between individuals with T6 or rostral and T6 caudal injuries. Conclusion: Significant differences in certain parts of cognitive functioning were found in individuals with SCI compared with age- and education level-matched controls. However, no significant differences were noted in any parts of cognitive functioning between individuals with T6 or rostral and T6 caudal injuries. Although cognitive impairment is an important sequelae following SCI, autonomic dysfunctions appear to have no effect on cognitive impairments in this population.

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

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 ...

Treatment of bilateral sacral insufficiency fractures with sacroplasty in a patient with motor complete tetraplegia

IntroductionOsteoporosis is a common secondary complication of spinal cord injury, with fragility fractures typically occurring in the lower body and management often is conservative.Case presentationWe present a 52-year-old male with chronic complete tetraplegia who presented to the emergency room with unremitting autonomic dysreflexia (AD). He was admitted for medical management of the AD when a source of the AD could not be identified. After an extensive workup, the patient was found to have bilateral sacral insufficiency fractures. He subsequently underwent sacroplasty with immediate and full resolution of AD symptoms and return to full premorbid function within 24 h.DiscussionPeople with chronic spinal cord injury (SCI) are at risk for spinal column fragility fractures in addition to lower extremity fractures. Vertebroplasty may be a safe option for treatment of insufficiency fractures in situations where conservative care may put people at risk for significant immobility-associated complications.

Evaluation of a re-engineered device for penile vibratory stimulation in men with spinal cord injury.

Cohort study OBJECTIVES: The purpose of this study was to evaluate the performance of a re-engineered device (Ferticare 2.0), which is replacing the previous standard (Ferticare 1.0) for penile vibratory stimulation in men with spinal cord injury. Most men with spinal cord injury are anejaculatory, requiring medical assistance to obtain their semen. Penile vibratory stimulation is generally recognized as the standard of care for semen retrieval in these anejaculatory men. Major Research University in Miami, Florida, USA. The Ferticare 2.0 device was applied to 15 men with spinal cord injury in a three-step protocol simulating normal use. Step 1: one device (2.5 mm amplitude, 100 Hz) was applied to the glans penis for 2 min. Step 2: If no ejaculation occurred, the amplitude was increased to 4.0 mm (100 Hz) and the device similarly applied. Step 3: If no ejaculation occurred, two devices, each 2.5 mm and 100 Hz were applied to the dorsum and frenulum of the glans penis. Participants at risk for autonomic dysreflexia were pretreated with sublingual nifedipine (20 mg), 15 min prior to stimulation. Blood pressure and other symptoms of autonomic dysreflexia were monitored. Participants answered a questionnaire about their experience with the device. Thirteen of 15 participants ejaculated with the device. No adverse events occurred. All participants commented they would recommend the device to other men with spinal cord injury. A re-engineered device, the Ferticare 2.0, is safe and effective for inducing ejaculation in men with spinal cord injury.

Automated Detection of Symptomatic Autonomic Dysreflexia Through Multimodal Sensing.

Objective: Autonomic Dysreflexia (AD) is a potentially life-threatening syndrome which occurs in individuals with higher level spinal cord injuries (SCI). AD is caused by triggers which can lead to rapid escalation of pathophysiological responses and if the trigger is not removed, AD can be fatal. There is currently no objective, non-invasive and accurate monitoring system available to automatically detect the onset of AD symptoms in real time in a non-clinical setting. Technology or Method: We developed a user-independent method of symptomatic AD detection in real time with a wearable physiological telemetry system (PTS) and a machine learning model using data from eleven participants with SCI. Results: The PTS could detect onset of AD symptoms with an average accuracy of 94.10% and a false negative rate of 4.89%. Conclusions: The PTS can detect the onset of the symptoms AD with high sensitivity and specificity to assist people with SCIs in preventing the occurrence of AD. It would enable persons with high level SCIs to be more independent and pursue vocational activities while granting continuous medical oversight. Clinical Impact: The PTS could serve as a supplementary tool to current solutions to detect the onset of AD and prepare individuals who are newly injured to be better prepared for AD episodes. Moreover, it could be translated into a system to encourage individuals to practice better healthcare management to prevent future occurrences.

Diverse cognitive impairment after spinal cord injury is associated with orthostatic hypotension symptom burden

This study: 1) compared cognitive functioning between individuals with chronic (>1 year) spinal cord injury (SCI) and non-injured controls and, 2) assessed associations between symptoms of autonomic dysreflexia and orthostatic hypotension with cognitive functioning in SCI participants with a history of unstable blood pressure (BP). Thirty-two individuals with SCI (C4–L2, American Spinal Injury Association Impairment Scale A-D) and thirty age, sex-matched non-injured controls participated in this study. Participants completed a motor-free neuropsychological test battery assessing 1) memory, 2) attention/concentration/psychomotor speed and, 3) executive function.Nineteen participants with SCI who had injuries ≥T6 and a history of unstable BP also completed the Autonomic Dysfunction Following Spinal Cord Injury (ADFSCI) questionnaire. Cognitive function was significantly lower in people with SCI across measures of memory and executive function compared to non-injured controls. Significant, moderate-to-large associations were observed between cumulative (frequency x severity) orthostatic hypotension and total BP instability symptoms scores, with measures of attention/concentration/psychomotor speed and executive function. These data demonstrate a 10 – 65% reduced performance across specific realms of cognitive functioning in individuals with SCI relative to non-injured controls. Furthermore, cumulative subjective scores for symptoms of unstable BP were associated with diverse cognitive deficits. These findings, in individuals without co-occurring traumatic brain injury, imply cardiovascular dysregulation plays a role in cognitive deficits observed in this population.

Protocol for a phase II, open-label exploratory study investigating the efficacy of fesoterodine for treatment of adult patients with spinal cord injury suffering from neurogenic detrusor overactivity for amelioration of autonomic dysreflexia

IntroductionManaging and preventing risk factors associated with cardiovascular and cerebrovascular impairment is well studied in able-bodied individuals. However, individuals with spinal cord injury (SCI) at or above the spinal segment...

Ancillary benefits of bladder chemodenervation for SCI neurogenic bladder.

Case series. Bladder chemodenervation is effective in treating neurogenic detrusor overactivity (NDO) in patients with neurogenic bladder due to spinal cord injury. Anecdotal reports also describe the improvement of non-bladder symptoms, specifically those related to autonomic dysreflexia (AD) and muscle spasticity. We conducted a study to further investigate this phenomenon. USA, Urban Tertiary Care Center. Twenty-one persons with SCI completed the study between March and December 2015. Mean age was 45 years (range 21-69). All were scheduled to undergo bladder chemodenervation with onabotulinumtoxinA 200 units to treat bothersome NDO refractory to oral medications. Each completed a questionnaire detailing symptoms unrelated to NDO immediately prior to the procedure, and again between 6 and 12 weeks after. All patients reported improvement in NDO symptoms following chemodenervation. Ten patients with prior symptoms of AD reported improvement in AD symptoms after injection. Seventeen patients reported skeletal muscle spasticity in the 3-month period before chemodenervation. In the follow up period, only 14 patients reported having muscle spasticity. In aggregate, 12 of 21 patients reported improvement of non-bladder symptomatology following chemodenervation. Chemodenervation of the bladder in patients with SCI can provide ancillary benefits in addition to mitigation of lower urinary symptoms. The mechanism may be related to dampening the bladder's ability to initiate noxious reflex responses.

Positive airway pressure therapy for sleep-disordered breathing confers short-term benefits to patients with spinal cord injury despite widely ranging patterns of use

Prospective, cohort study. To evaluate the effectiveness of bi-level positive airway pressure (PAP) therapy and the patterns of use for sleep-disordered breathing (SDB) in individuals with spinal cord injury (SCI). Academic tertiary care center, USA. Overall, 91 adults with C1-T6 SCI for ≥3 months were recruited and 74 remained in the study to be evaluated for SDB and follow-up. Individuals with SDB but no nocturnal hypercapnia (NH) were prescribed auto-titrating PAP. Those with NH were prescribed PAP with volume-assured pressure support. Device downloads and overnight transcutaneous capnography were performed at 3, 6, and 12 months to quantify PAP use and effectiveness. Participants kept daily event logs, and quality of life (QOL) questionnaires were performed after 3, 6, and 12 months. Overall, 45% of 91 participants completed the study. There was great diversity among SCI patients in PAP utilization; after 3 months, 37.8% of participants used PAP for ≥70% nights and ≥240 min per night, whereas 42.2% seldom used PAP and 20% used PAP sporadically or for short periods. PAP therapy was effective in improving OSA in 89% and nocturnal hypercapnia in 77%. Higher PAP pressures predicted higher levels of device use. There were marked reductions in symptoms of autonomic dysreflexia (AD) and orthostatic hypotension as well as some improved indices of QOL. Despite widely diverse patterns of use, PAP therapy may have short-term benefits with regard to QOL and reducing episodes of dizziness and autonomic dysreflexia.

Cardiovascular Monitoring During Video Urodynamic Studies in Persons With Spinal Cord Injury.

The aims of the study were to observe cardiovascular responses during video urodynamic studies and to identify correlations between autonomic dysreflexia events and video urodynamic study findings in spinal cord injuries. Thirty-four persons with spinal cord injury were enrolled and investigated using continuous cardiovascular monitoring during video urodynamic studies. Associations between cardiovascular responses and video study variables were analyzed. Bladder type-specific cardiovascular responses occurred during the study. The incidence of overactive detrusor during urodynamic study and bladder trabeculation on voiding cystourethrogram was significantly higher in autonomic dysreflexia persons with spinal cord injury (P < 0.05). Systolic blood pressure changes showed moderate negative correlation (r = -0.402, P = 0.020) with bladder compliance and high positive correlation (r = 0.810, P = 0.000) with maximum detrusor pressure. However, no significant differences in neurological level of injury, injury completeness, autonomic dysreflexia symptoms, and voiding type were found. Spinal cord injury increase at each section was significantly higher in overactive detrusor group (P < 0.05). Significant bradycardia or tachycardia correlating with autonomic dysreflexia during urodynamic studies was not observed. Unpredictable cardiovascular reactions during urodynamic study should be considered carefully in persons with a spinal cord injury above T6. Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME CME OBJECTIVES: Upon completion of this article, the reader should be able to: (1) Describe limitations of previous cardiovascular monitoring during urodynamic study to observe changes in cardiovascular responses; (2) Identify factors contributing to autonomic dysreflexia during urodynamic testing; and (3) Discuss the effect of morphologic features in voiding cystourethrogram including trabeculation and vesicourethral reflux on autonomic dysreflexia. Advanced ACCREDITATION: The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 0.5 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Intracerebral haemorrhage following uncontrolled autonomic dysreflexia post suprapubic catheter placement surgery.

We describe a case of intracerebral haemorrhage (ICH) following uncontrolled episodes of autonomic dysreflexia (AD) within 24 h of a minor urological procedure. A 33-year-old active paraplegic patient T1 Association Impairment Scale A underwent an elective suprapubic catheter (SPC) placement for bladder management. The surgery was done under general anaesthesia and was uneventful. Four hours after surgery, he developed haematuria and multiple blood clots in the urine, which eventually caused blockage of the SPC and resulted in symptomatic AD. The clots and blockage persisted, which continued to trigger repeated episodes of increased blood pressure (BP) and AD. Despite medical treatment with sublingual nitrate to lower the increased BP, the patient subsequently developed massive left ICH presenting with right upper limb weakness, facial asymmetry and inability to speak. He continued to have fluctuating BP measurements for 11 days post event with severe hypertensive and hypotensive episodes. This presented a challenge in the BP management as well as post-ICH management. He underwent an intensive neurorehabilitation programme as soon as the BP had stabilized. Severe neurological complications of AD are rare. In this case report, we highlight the importance of close monitoring of BP and AD symptoms after an SPC procedure, the challenges in BP management and the subsequent importance of an early rehabilitation programme after ICH secondary to uncontrolled AD.

Effect of imidafenacin on the urodynamic parameters of patients with indwelling bladder catheters due to spinal cord injury

Study design:A retrospective study.Objectives:To investigate the effect of imidafenacin on the urodynamic parameters of patients with indwelling bladder catheters due to spinal cord injury (SCI).Setting:Spinal center (Tokyo, Japan).Methods:Imidafenacin was prescribed to 34 patients with SCI who had a low cystometric volume and/or detrusor compliance according to a urodynamic study. A low cystometric volume and detrusor compliance were defined as <200 ml and <20 ml cm−1 H2O, respectively. The urodynamic study was repeated 4 weeks after imidafenacin was prescribed. When the urodynamic parameters did not improve in the follow-up study, the dose of imidafenacin was increased twofold. Then the urodynamic study was repeated 4 weeks thereafter. We compared the urodynamic parameters before and after imidafenacin treatment. Complications such as vesico-urethral reflux (VUR) and autonomic dysreflexia (AD) were documented.Results:Fifteen patients took 0.2 mg of imidafenacin daily, and 19 received 0.4 mg of imidafenacin daily. Imidafenacin increased the cystometric volume from 246.0 to 321.5 ml (median, P=0.002), detrusor compliance from 6.67 ml cm−1 H2O to 8.98 ml cm−1 H2O (median, P=0.012), and decreased the detrusor pressure from 37.0 cm H2O to 30.5 cm H2O (median, P=0.056). All three patients who had VUR fully recovered. Although 3 of 12 patients recovered from AD, 3 patients newly developed symptoms of AD. No patient withdrew from treatment due to adverse effects.Conclusion:Imidafenacin is a safe drug that may improve the urodynamic parameters of patients with SCI, and it possibly alleviates bladder complications.

Cardiovascular response during urodynamics in individuals with spinal cord injury.

Retrospective chart review. To establish the frequency and severity of autonomic dysreflexia (AD) during urodynamics among individuals with chronic spinal cord injury (SCI) and to investigate the possible effect of the number of years since SCI on the severity of AD. SCI outpatient clinic. A retrospective chart review was undertaken of individuals with SCI who were seen at an outpatient clinic and could potentially develop an episode of AD (T6 and above). Data regarding age, gender, urodynamic examination, lower urinary tract function, cardiovascular parameters and SCI were collected. In addition, information on signs and symptoms of AD were retrieved. A total of 76 individuals with SCI were examined with blood pressure (BP) monitoring. The majority had cervical SCI (79%). The mean age was 47.8±13.9 years. The median duration after SCI was 51.5 months. During urodynamics, a total of 48 (63.2%) individuals showed an increase in systolic BP>20 mm Hg, meeting the criteria for AD. Indicators for higher incidences of AD were cervical SCI, being >2 years after SCI, the presence of detrusor sphincter dyssynergia (DSD) and low bladder compliance. AD was more severe in individuals with complete (American Spinal Cord Association (ASIA) impairment scale (AIS) A) injuries, worse with greater time after SCI. 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.

The risk of intra-urethral Foley catheter balloon inflation in spinal cord-injured patients: Lessons learned from a retrospective case series.

BackgroundInflating the balloon of Foley catheter in urethra is a complication of urethral catheterisation. We report five patients in whom this complication occurred because of unskilled catheterisation. Due to lack of awareness, the problem was not recognised promptly and patients came to harm.Case seriesA tetraplegic patient developed pain in lower abdomen and became unwell after transurethral catheterisation. CT pelvis revealed full bladder with balloon of Foley catheter in dilated urethra.Routine ultrasound examination in an asymptomatic tetraplegic patient with urethral catheter drainage, revealed Foley balloon in the urethra. He was advised to get catheterisations done by senior health professionals.A paraplegic patient developed bleeding and bypassing after transurethral catheterisation. X-ray revealed Foley balloon in urethra; urethral catheter was changed ensuring its correct placement in urinary bladder. Subsequently, balloon of Foley catheter was inflated in urethra several times by community nurses, which resulted in erosion of bulbous urethra and urinary fistula. Suprapubic cystostomy was performed.A tetraplegic patient developed sweating and increased spasms following urethral catheterisations. CT of abdomen revealed distended bladder with the balloon of Foley catheter located in urethra. Flexible cystoscopy and transurethral catheterisation over a guide-wire were performed. Patient noticed decrease in sweating and spasms.A paraplegic patient developed lower abdominal pain and nausea following catheterisation. CT abdomen revealed bilateral hydronephrosis and hydroureter and Foley balloon located in urethra. Urehral catheterisation was performed over a guide-wire after cystoscopy. Subsequently suprapubic cystostomy was done.ConclusionSpinal cord injury patients are at increased risk for intra-urethral Foley catheter balloon inflation because of lack of sensation in urethra, urethral sphincter spasm, and false passage due to previous urethral trauma. Education and training of doctors and nurses in proper technique of catheterisation in spinal cord injury patients is vital to prevent intra-urethral inflation of Foley catheter balloon. If a spinal cord injury patient develops bypassing or symptoms of autonomic dysreflexia following catheterisation, incorrect placement of urethral catheter should be suspected.

Monitoring development of autonomic dysreflexia during urodynamic investigation in patients with spinal cord injury

Objectives: We aimed to investigate whether autonomic dysreflexia (AD) develops during urodynamic investigation in patients with spinal cord injury (SCI) with neurological level below thoracic (T) 6 together with the frequency and related factors for AD development.Study Design: Prospective study.Methods: The systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate (HR) of 51 SCI patients with a neurological level below T6 were measured and recorded at the beginning and every two minutes during the filling phase of the urodynamic study. The changes between the SBP, DBP and HR values at the beginning and end of the filling phase were analyzed.Results: Autonomic dysreflexia developed only in one of the 51 patients included into the study. The BP of this patient increased from 105/76 mmHg to 145/102 mmHg and the HR dropped from 88 beats/minute (bpm) to 69 bpm together with development of the AD symptoms. The patient was a 47-year-old male with a neurological level at T8. A significant difference was found between the mean SBP and the mean DBP values at the beginning and end of the filling phase.Conclusions: Although rare, AD can be seen during urodynamic investigation in patients with a neurological level below T6, especially when close to the T6 level. Therefore, we suggest that the patients with a neurological level below T6 and especially closer to T6 level should be followed-up in terms of development of AD. The clinicians should take into account the HR values in addition to the the SBP and DBP values at follow-ups.

Iatrogenic urological triggers of autonomic dysreflexia: a systematic review.

This is a systematic review. The objective of this study was to review the literature on iatrogenic urological triggers of autonomic dysreflexia (AD). This study was conducted in an international setting. A systematic review was conducted from PubMed search using AD/ autonomic hyperreflexia and spinal cord injury (SCI). Studies selected for review involved iatrogenic urological triggers of AD in individuals with SCI, including original articles, previous practice guidelines, case reports and literature reviews. Studies that did not report AD or blood pressure (BP) assessments during urological procedures were excluded. Forty studies were included for analysis and categorized into four groups: (1) urodynamics and cystometry; (2) cystoscopy and transurethral litholapaxy; (3) extracorporeal shock-wave lithotripsy (ESWL); and (4) other procedures. During urodynamics, the incidence of AD ranged from 36.7% to 77.8%. The symptomatic rate ranged from 50% to 65%, with AD symptoms seen predominantly in cervical SCI patients. The studies imply no consensus regarding the relationship between AD, neurogenic detrusor overactivity and detrusor sphincter dyssynergia. Without anesthesia, the majority of individuals develop AD during cystoscopy, transurethral litholapaxy and ESWL. The effectiveness of different anesthesia methods relies on blocking the nociceptive signals from the lower urinary tract (LUT) below the level of the neurological lesion. Other iatrogenic urological triggers were commonly associated with bladder filling. The LUT triggers of episodes of AD are often associated with iatrogenic urological procedures. AD was more prevalent in cervical SCI than in thoracic SCI. To detect this potential life-threatening complication following cervical and high thoracic SCI, routine BP monitoring during urological procedures is highly recommended.