Iatrogenic Urological Triggers of Autonomic Dysreflexia: a Systematic Review

Overview

Journal Spinal Cord

Specialty Neurology

Date 2015 Mar 25

PMID 25800696

Citations 13

Authors

N Liu

M Zhou

F Biering-Sorensen

A V Krassioukov

Affiliations

Soon will be listed here.

Abstract

Study Design: This is a systematic review.

Objective: The objective of this study was to review the literature on iatrogenic urological triggers of autonomic dysreflexia (AD).

Setting: This study was conducted in an international setting.

Methods: 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.

Results: 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.

Conclusion: 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.

Citing Articles

From Toxin to Treatment: A Narrative Review on the Use of Botulinum Toxin for Autonomic Dysfunction.

Rempel L, Malik R, Shackleton C, Calderon-Juarez M, Sachdeva R, Krassioukov A Toxins (Basel). 2024; 16(2).

PMID: 38393175 PMC: 10892370. DOI: 10.3390/toxins16020096.

Autonomic dysreflexia in urological practice: pathophysiology, prevention and treatment considerations.

Calderon-Juarez M, Samejima S, Rempel L, Sachdeva R, Krassioukov A World J Urol. 2024; 42(1):80.

PMID: 38358540 DOI: 10.1007/s00345-024-04781-0.

Targeting bladder function with network-specific epidural stimulation after chronic spinal cord injury.

Herrity A, Aslan S, Mesbah S, Siu R, Kalvakuri K, Ugiliweneza B Sci Rep. 2022; 12(1):11179.

PMID: 35778466 PMC: 9249897. DOI: 10.1038/s41598-022-15315-2.

Automatic detection of the mental state in responses towards relaxation.

Sagastibeltza N, Salazar-Ramirez A, Martinez R, Jodra J, Muguerza J Neural Comput Appl. 2022; 35(8):5679-5696.

PMID: 35698721 PMC: 9178946. DOI: 10.1007/s00521-022-07435-7.

Perioperative Complications and Anesthesia Practices in Managing Patients With Quadriplegia Undergoing Surgery: A Systematic Review.

Aziz Rizk A, Saad M, Singh M, Schaller B, Venkatraghavan L, Chowdhury T Front Med (Lausanne). 2022; 9:852892.

PMID: 35419369 PMC: 8996073. DOI: 10.3389/fmed.2022.852892.

References

Sayilir S, Ersoz M, Yalcin S . Comparison of urodynamic findings in patients with upper and lower cervical spinal cord injury. Spinal Cord. 2013; 51(10):780-3. DOI: 10.1038/sc.2013.83. View

Rapidi C, Petropoulou K, Galata A, Fragkaki M, Kandylakis E, Venieri M . Neuropathic bladder dysfunction in patients with motor complete and sensory incomplete spinal cord lesion. Spinal Cord. 2008; 46(10):673-8. DOI: 10.1038/sc.2008.16. View

Kabalin J, Lennon S, Gill H, Wolfe V, Perkash I . Incidence and management of autonomic dysreflexia and other intraoperative problems encountered in spinal cord injury patients undergoing extracorporeal shock wave lithotripsy without anesthesia on a second generation lithotriptor. J Urol. 1993; 149(5):1064-7. DOI: 10.1016/s0022-5347(17)36297-3. View

Vaidyanathan S, Watt J, Soni B, Krishnan K . Intravenous salbutamol treatment for penile erection arising during cystoscopy of cervical spinal cord injury patients. Spinal Cord. 1996; 34(11):691-5. DOI: 10.1038/sc.1996.125. View

Yoo K, Jeong C, Kim S, Chung S, Bae H, Oh K . Sevoflurane concentrations required to block autonomic hyperreflexia during transurethral litholapaxy in patients with complete spinal cord injury. Anesthesiology. 2008; 108(5):858-63. DOI: 10.1097/ALN.0b013e31816c8a00. View

Vaidyanathan S, Soni B, Sett P, Singh G, Oo T, Hughes P . Flawed trial of micturition in cervical spinal cord injury patients: guidelines for trial of voiding in men with tetraplegia. Spinal Cord. 2003; 41(12):667-72. DOI: 10.1038/sj.sc.3101519. View

Kewalramani L . Autonomic dysreflexia in traumatic myelopathy. Am J Phys Med. 1980; 59(1):1-21. View

Hansen J, Media S, Nohr M, Biering-Sorensen F, Sinkjaer T, Rijkhoff N . Treatment of neurogenic detrusor overactivity in spinal cord injured patients by conditional electrical stimulation. J Urol. 2005; 173(6):2035-9. DOI: 10.1097/01.ju.0000158160.11083.1b. View

Eltorai I, Kim R, VULPE M, Kasravi H, Ho W . Fatal cerebral hemorrhage due to autonomic dysreflexia in a tetraplegic patient: case report and review. Paraplegia. 1992; 30(5):355-60. DOI: 10.1038/sc.1992.82. View

10.

Claydon V, Elliott S, Sheel A, Krassioukov A . Cardiovascular responses to vibrostimulation for sperm retrieval in men with spinal cord injury. J Spinal Cord Med. 2006; 29(3):207-16. PMC: 1864810. DOI: 10.1080/10790268.2006.11753876. View

11.

Robert M, Bennani A, Ohanna F, Guiter J, Averous M, Grasset D . The management of upper urinary tract calculi by piezoelectric extracorporeal shock wave lithotripsy in spinal cord injury patients. Paraplegia. 1995; 33(3):132-5. DOI: 10.1038/sc.1995.29. View

12.

Yarkony G, Katz R, Wu Y . Seizures secondary to autonomic dysreflexia. Arch Phys Med Rehabil. 1986; 67(11):834-5. View

13.

Yoo K, Jeong C, Kim W, Lee H, Kim S, Jeong S . Fatal cerebral hemorrhage associated with autonomic hyperreflexia during surgery in the prone position in a quadriplegic patient: a case report. Minerva Anestesiol. 2010; 76(7):554-8. View

14.

Chancellor M, Lavelle J, Ozawa H, Jung S, Watanabe T, Kumon H . Ice-water test in the urodynamic evaluation of spinal cord injured patients. Tech Urol. 1998; 4(2):87-91. View

15.

Chancellor M, Rivas D, Erhard M, Hirsch I, Bagley D . Flexible cystoscopy during urodynamic evaluation of spinal cord-injured patients. J Endourol. 1993; 7(6):531-5. DOI: 10.1089/end.1993.7.531. View

16.

Yoo K, Jeong C, Kim S, Jeong S, Kim W, Lee H . Remifentanil decreases sevoflurane requirements to block autonomic hyperreflexia during transurethral litholapaxy in patients with high complete spinal cord injury. Anesth Analg. 2010; 112(1):191-7. DOI: 10.1213/ANE.0b013e3181fc7139. View

17.

Courtois F, Rodrigue X, Cote I, Boulet M, Vezina J, Charvier K . Sexual function and autonomic dysreflexia in men with spinal cord injuries: how should we treat?. Spinal Cord. 2012; 50(12):869-77. DOI: 10.1038/sc.2012.83. View

18.

Valles M, Benito J, Portell E, Vidal J . Cerebral hemorrhage due to autonomic dysreflexia in a spinal cord injury patient. Spinal Cord. 2005; 43(12):738-40. DOI: 10.1038/sj.sc.3101780. View

19.

Perkash I . Autonomic dysreflexia and detrusor-sphincter dyssynergia in spinal cord injury patients. J Spinal Cord Med. 1997; 20(3):365-70. View

20.

West C, Wong S, Krassioukov A . Autonomic cardiovascular control in Paralympic athletes with spinal cord injury. Med Sci Sports Exerc. 2013; 46(1):60-8. DOI: 10.1249/MSS.0b013e31829e46f3. View