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

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Abstract

Purpose

Spinal cord injury (SCI) leads to sensorimotor impairments; however, it can also be complicated by significant autonomic dysfunction, including cardiovascular and lower urinary tract (LUT) dysfunctions. Autonomic dysreflexia (AD) is a dangerous cardiovascular complication of SCI often overlooked by healthcare professionals. AD is characterized by a sudden increase in blood pressure (BP) that can result in severe cardiovascular and cerebrovascular complications. In this review, we provide an overview on the clinical manifestations, risk factors, underlying mechanisms, and current approaches in prevention and management of AD.

Methods

After conducting a literature research, we summarized relevant information regarding the clinical and pathophysiological aspects in the context of urological clinical practice

Conclusions

The most common triggers of AD are those arising from LUT, such as bladder distention and urinary tract infections. Furthermore, AD is commonly observed in individuals with SCI during urological procedures, including catheterization, cystoscopy and urodynamics. Although significant progress in the clinical assessment of AD has been made in recent decades, effective approaches for its prevention and treatment are currently lacking.

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Data availability

The data sets used and/or analyzed during the current study are available from the corresponding author on request.

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Acknowledgments

All equipment used for this study was funded via grant support by the Canadian Foundation for Innovation/BC Knowledge Development Fund (CFI/ BCKDF) (35869). Principal investigator was A.V.K. A.V.K. holds an endowed chair in rehabilitation medicine, University of British Columbia, and his laboratory is supported by funds from the Canadian Institute for Health Research (PJT-156033), Rick Hansen Foundation (35869 IOF), Praxis Spinal Cord Institute (#G2021-30), United States Department of Defense (W81XWH-22-1-0929), International Spinal Research Trust (#GR019728), and the Wings for Life Spinal Cord Research Foundation (WFL-CA-20/21). M.C.-J. is supported by the Paralyzed Veterans of America Fellowship (#3202). S.S. is supported by a Paralyzed Veterans of America post-doctoral fellowship award (#3190), the Rick Hansen Foundation (#2007-21), and the Wings for Life Spinal Cord Research Foundation (#2020_097). L.R. is supported by the University of British Columbia Faculty of Medicine Summer Student Research Program Award. R.S. is supported by Wings for Life Spinal Cord Research Foundation (Proj. 260) and the United States Department of Defense (SC21007). The authors acknowledge the support of the Praxis Spinal Cord Institute (G2021-34) for the research planning and the International Spinal Research Trust (BBS 004) as the major funder of this study. The sponsors of the study had no role in study design, data collection, data analysis, data interpretation, or writing of the report.

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Authors and Affiliations

  1. International Collaboration On Repair Discoveries, Faculty of Medicine, The University of British Columbia, 818 West 10th Avenue, Vancouver, BC, V5Z 1M9, Canada

    Martín Calderón-Juárez, Soshi Samejima, Lucas Rempel, Rahul Sachdeva & Andrei Krassioukov

  2. Division of Physical Medicine and Rehabilitation, Department of Medicine, The University of British Columbia, Vancouver, Canada

    Martín Calderón-Juárez, Soshi Samejima, Rahul Sachdeva & Andrei Krassioukov

  3. Faculty of Medicine, The University of British Columbia, Vancouver, Canada

    Lucas Rempel

  4. GF Strong Rehabilitation Centre, Vancouver Coastal Health, Vancouver, BC, Canada

    Andrei Krassioukov

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  1. Martín Calderón-Juárez
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  2. Soshi Samejima
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  3. Lucas Rempel
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  4. Rahul Sachdeva
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Contributions

MC-J was contributed to project development, data management, data analysis, manuscript writing, manuscript editing. SS was contributed to project development, data management, data analysis, manuscript writing, manuscript editing. LR was contributed to project development, data management, data analysis, manuscript writing, manuscript editing. RS was contributed to project development, data analysis, manuscript writing, manuscript editing. AK was contributed to project development, data analysis, manuscript writing, manuscript editing.

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Correspondence to Andrei Krassioukov.

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Ethical approval was granted by the Clinical Research Ethics Board of the University of British Columbia (H20-01163) and the Vancouver Coastal Health Research Institute (V20-01163). All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments. Research participants included in this study provided their written informed consent.

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Calderón-Juárez, M., Samejima, S., Rempel, L. et al. Autonomic dysreflexia in urological practice: pathophysiology, prevention and treatment considerations. World J Urol 42, 80 (2024). https://doi.org/10.1007/s00345-024-04781-0

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