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760 Pay attention to autonomic dysreflexia in patients with spinal cord injury during urodynamic investigation!
760
Pay attention to autonomic dysreflexia in patients with spinal cord injury during urodynamic investigation! Eur Urol Suppl 2014;13;e760
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Walter M. 1 , Sammer U.1 , Guggenbühl-Roy S. 1 , Birnböck D.1 , Knüpfer S. 1 , Mehnert U.1 , Schubert M. 2 , Kessler T.M.1 1 Spinal
Cord Injury Center & Research, Balgrist University Hospital, Dept. of Neuro-Urology, Zürich, Switzerland, 2 Spinal Cord Injury Center
& Research, Balgrist University Hospital, Dept. of Neurology, Zürich, Switzerland INTRODUCTION & OBJECTIVES: Autonomic dysreflexia (AD) is a severe and potentially life-threatening condition in patients with neurogenic lower urinary tract dysfunction (NLUTD) due to suprasacral spinal cord injury (SCI). This phenomenon, characterized by extreme systolic blood pressure (SBP) increase and often accompanied by heart rate (HR) decrease and corresponding clinical symptoms, requires immediate medical intervention to avoid severe complications, which can even lead to death. Urodynamic investigation (UDI) is the gold standard to assess SCI but this may induce AD. Thus, the aim of the present study was to investigate the incidence of AD during UDI in patients with suprasacral SCI. MATERIAL & METHODS: Overall, 242 male patients (mean age 51±16 years) with suprasacral SCI (mean duration of injury 11±11 years) who underwent continuous non-invasive cardiovascular monitoring during UDI were prospectively investigated at a single university spinal cord injury centre. SBP, diastolic blood pressure (DBP) and HR were recorded continuously during UDI. We defined AD according to the guidelines of the International Standards for Neurological Classification of SCI (ISNCSCI). RESULTS: Overall incidence of AD was 63% (153/242) and in those SBP increase (54±31 vs. 8±13 mmHg), DBP increase (20±13 vs. 5±7 mmHg) and HR decrease [-11±15 vs. -1±9 beats per minute (bpm)] were significantly different (p<0.001) than in the remaining patients (89/242). Within the group of the 153 patients with AD, those with a spinal cord lesion at or above Th6 (95/153) showed significantly different (p<0.001) SBP increase (62±32 vs. 42±24 mmHg), DBP increase (23±14 vs. 15±10 mmHg) and HR decrease (-15±15 vs. -5±13 bpm) compared to those with a lesion below Th6 (58/153). Patients suffering from a complete lesion [American Spinal Injury Association Impairment Scale (AIS) A, 53/153] compared to those with an incomplete lesion (AIS B-D, 100/153) showed a significantly different HR decrease (-19±15 vs. -7±14 bpm, p<0.001). Patients (44/153) with symptomatic AD (clinical symptoms) demonstrated significantly (p<0.001) higher SBP increase (75±30 vs. 45±27 mmHg), DBP increase (28±12 vs. 17±12 mmHg) and HR decrease (-20±13 vs. -8±15 bpm) compared to the asymptomatic AD patients (109/153). CONCLUSIONS: We found an unexpectedly high incidence of AD in more than 60% of our male patients with NLUTD due to suprasacral SCI. Considering the risks involved with sudden hypertension, we highly recommend continuous cardiovascular monitoring during UDI in all men with a suprasacral SCI.
Pay attention to autonomic dysreflexia in patients with spinal cord injury during urodynamic investigation! Eur Urol Suppl 2014;13;e760
Print! Print!
Walter M. 1 , Sammer U.1 , Guggenbühl-Roy S. 1 , Birnböck D.1 , Knüpfer S. 1 , Mehnert U.1 , Schubert M. 2 , Kessler T.M.1 1 Spinal
Cord Injury Center & Research, Balgrist University Hospital, Dept. of Neuro-Urology, Zürich, Switzerland, 2 Spinal Cord Injury Center
& Research, Balgrist University Hospital, Dept. of Neurology, Zürich, Switzerland INTRODUCTION & OBJECTIVES: Autonomic dysreflexia (AD) is a severe and potentially life-threatening condition in patients with neurogenic lower urinary tract dysfunction (NLUTD) due to suprasacral spinal cord injury (SCI). This phenomenon, characterized by extreme systolic blood pressure (SBP) increase and often accompanied by heart rate (HR) decrease and corresponding clinical symptoms, requires immediate medical intervention to avoid severe complications, which can even lead to death. Urodynamic investigation (UDI) is the gold standard to assess SCI but this may induce AD. Thus, the aim of the present study was to investigate the incidence of AD during UDI in patients with suprasacral SCI. MATERIAL & METHODS: Overall, 242 male patients (mean age 51±16 years) with suprasacral SCI (mean duration of injury 11±11 years) who underwent continuous non-invasive cardiovascular monitoring during UDI were prospectively investigated at a single university spinal cord injury centre. SBP, diastolic blood pressure (DBP) and HR were recorded continuously during UDI. We defined AD according to the guidelines of the International Standards for Neurological Classification of SCI (ISNCSCI). RESULTS: Overall incidence of AD was 63% (153/242) and in those SBP increase (54±31 vs. 8±13 mmHg), DBP increase (20±13 vs. 5±7 mmHg) and HR decrease [-11±15 vs. -1±9 beats per minute (bpm)] were significantly different (p<0.001) than in the remaining patients (89/242). Within the group of the 153 patients with AD, those with a spinal cord lesion at or above Th6 (95/153) showed significantly different (p<0.001) SBP increase (62±32 vs. 42±24 mmHg), DBP increase (23±14 vs. 15±10 mmHg) and HR decrease (-15±15 vs. -5±13 bpm) compared to those with a lesion below Th6 (58/153). Patients suffering from a complete lesion [American Spinal Injury Association Impairment Scale (AIS) A, 53/153] compared to those with an incomplete lesion (AIS B-D, 100/153) showed a significantly different HR decrease (-19±15 vs. -7±14 bpm, p<0.001). Patients (44/153) with symptomatic AD (clinical symptoms) demonstrated significantly (p<0.001) higher SBP increase (75±30 vs. 45±27 mmHg), DBP increase (28±12 vs. 17±12 mmHg) and HR decrease (-20±13 vs. -8±15 bpm) compared to the asymptomatic AD patients (109/153). CONCLUSIONS: We found an unexpectedly high incidence of AD in more than 60% of our male patients with NLUTD due to suprasacral SCI. Considering the risks involved with sudden hypertension, we highly recommend continuous cardiovascular monitoring during UDI in all men with a suprasacral SCI.