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World Journal of Urology
Published in: World Journal of Urology 3/2016

01-03-2016 | Original Article

Autonomic dysreflexia and repeatability of cardiovascular changes during same session repeat urodynamic investigation in women with spinal cord injury

Authors: Matthias Walter, Stephanie C. Knüpfer, Lorenz Leitner, Ulrich Mehnert, Martin Schubert, Armin Curt, Thomas M. Kessler

Published in: World Journal of Urology | Issue 3/2016

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Abstract

Purpose

To investigate autonomic dysreflexia (AD) and repeatability of cardiovascular changes during same session repeat urodynamic investigation (UDI) in women with spinal cord injury (SCI).

Methods

Prospective investigation of 33 consecutive women with suprasacral SCI suffering from neurogenic lower urinary tract dysfunction (NLUTD) undergoing same session repeat UDI and synchronous continuous cardiovascular monitoring [systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate (HR)]. UDIs were performed according to the International Continence Society guidelines. AD was defined according to the International Standards to document remaining Autonomic Function after SCI. Neurological level of SCI was determined using the American Spinal Injury Association impairment scale.

Results

Mean age and duration since SCI of the 33 women were 58 ± 19 and 6 ± 11 years, respectively. Overall AD incidence was 73 % (24/33), and 19 of the 33 women (58 %) showed AD in both UDIs. The repeatability of detecting AD between the two same session UDIs was good (κ = 0.67, 95 % CI 0.4–0.94). When applying the Bland and Altman method, wide 95 % limits of agreement for differences in same session SBP, DBP and HR indicated poor repeatability. There was a significant increase in SBP (p < 0.001) and DBP (p < 0.001) and a significant decrease in HR (p = 0.007) in patients with compared to those without AD.

Conclusions

In all women with NLUTD due to suprasacral SCI, we strongly recommend continuous cardiovascular monitoring during UDI and repeat measurements considering the high incidence of AD, the relevant risks involved with sudden hypertension and the poor repeatability of cardiovascular monitoring.
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Metadata
Title
Autonomic dysreflexia and repeatability of cardiovascular changes during same session repeat urodynamic investigation in women with spinal cord injury
Authors
Matthias Walter
Stephanie C. Knüpfer
Lorenz Leitner
Ulrich Mehnert
Martin Schubert
Armin Curt
Thomas M. Kessler
Publication date
01-03-2016
Publisher
Springer Berlin Heidelberg
Published in
World Journal of Urology / Issue 3/2016
Print ISSN: 0724-4983
Electronic ISSN: 1433-8726
DOI
https://doi.org/10.1007/s00345-015-1589-1

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