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.