title: Iatrogenic urological triggers of autonomic dysreflexia: a systematic review.
abstract: METHODS
  This is a systematic review.
  
  
  OBJECTIVE
  The objective of this study was to review the literature on iatrogenic urological triggers of autonomic dysreflexia (AD).
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors: 1] Department of Rehabilitation Medicine, Peking University Third Hospital, Beijing, China [2] International Collaboration on Repair Discoveries (ICORD), Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
authors: N
authors: N
authors: Liu
authors: Department of Rehabilitation Medicine, Peking University Third Hospital, Beijing, China.
authors: M
authors: M
authors: Zhou
authors: Department for Spinal Cord Injuries, Glostrup Hospital, University of Copenhagen, Copenhagen, Denmark.
authors: F
authors: F
authors: Biering-Sørensen
authors: 1] International Collaboration on Repair Discoveries (ICORD), Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada [2] Division of Physical Medicine and Rehabilitation, University of British Columbia, Vancouver, British Columbia, Canada [3] GF Strong Rehabilitation Centre, Vancouver Coastal Health, Vancouver, British Columbia, Canada.
authors: A V
authors: AV
authors: Krassioukov
mesh_terms: D020211:Autonomic Dysreflexia / Q000453:epidemiology / Q000209:etiology*; D003950:Diagnostic Techniques, Urological / Q000009:adverse effects* / Q000706:statistics & numerical data; D006801:Humans; D007049:Iatrogenic Disease / Q000453:epidemiology; D013520:Urologic Surgical Procedures / Q000009:adverse effects* / Q000706:statistics & numerical data