title: Autonomic dysreflexia and repeatability of cardiovascular changes during same session repeat urodynamic investigation in women with spinal cord injury.
abstract: OBJECTIVE
  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.
authors.affiliation: Neuro-Urology, Spinal Cord Injury Center and Research, University of Zürich, Balgrist University Hospital, Zürich, Switzerland.
authors.forename: Matthias
authors.initials: M
authors.lastname: Walter
authors.affiliation: Neuro-Urology, Spinal Cord Injury Center and Research, University of Zürich, Balgrist University Hospital, Zürich, Switzerland.
authors.forename: Stephanie C
authors.initials: SC
authors.lastname: Knüpfer
authors.affiliation: Neuro-Urology, Spinal Cord Injury Center and Research, University of Zürich, Balgrist University Hospital, Zürich, Switzerland.
authors.forename: Lorenz
authors.initials: L
authors.lastname: Leitner
authors.affiliation: Neuro-Urology, Spinal Cord Injury Center and Research, University of Zürich, Balgrist University Hospital, Zürich, Switzerland.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Mehnert
authors.affiliation: Neurology, Spinal Cord Injury Center and Research, University of Zürich, Balgrist University Hospital, Zürich, Switzerland.
authors.forename: Martin
authors.initials: M
authors.lastname: Schubert
authors.affiliation: Neurology, Spinal Cord Injury Center and Research, University of Zürich, Balgrist University Hospital, Zürich, Switzerland.
authors.forename: Armin
authors.initials: A
authors.lastname: Curt
authors.affiliation: Neuro-Urology, Spinal Cord Injury Center and Research, University of Zürich, Balgrist University Hospital, Zürich, Switzerland. tkessler@gmx.ch.
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Kessler
mesh_terms: D000368:Aged; D020211:Autonomic Dysreflexia / Q000150:complications / Q000503:physiopathology*; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D015994:Incidence; D008159:Lumbar Vertebrae; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012008:Recurrence; D013119:Spinal Cord Injuries / Q000150:complications* / Q000503:physiopathology; D013557:Switzerland / Q000453:epidemiology; D013997:Time Factors; D001743:Urinary Bladder / Q000503:physiopathology*; D014563:Urodynamics / Q000502:physiology*
keywords: Autonomic dysreflexia; Neurogenic lower urinary dysfunction; Spinal cord injury; Urodynamic investigation