Autonomic dysreflexia and detrusor-sphincter dyssynergia in spinal cord injury patients.

This study reevaluates the significance of our previously reported blood pressure monitoring during cystometrographic studies in spinal cord injury patients who had detrusor-sphincter dyssynergia. We have now evaluated 26 spinal cord injury patients (21 tetraplegics and five high paraplegics) with complex urodynamic studies both before and after transurethral modified sphincterotomy (TURS). In these patients, mean systolic rise prior to TURS was 32.4 mm Hg (S.D. +/- 16.3) and diastolic rise was 14.3 mm Hg (S.D. +/- 9.3). Following TURS, mean systolic rise was 15.5 +/- 0.1 and diastolic rise was 7.3 +/- 8.6. This is a statistically significant difference (p value .001). Following TURS, blood pressure rises were transitory and not associated with significant symptoms of autonomic dysreflexia. The present study confirms our previous findings that a high correlation exists between the magnitude of blood pressure response, level of injury and severity of detrusor-sphincter dyssynergia. These results indicate that following the modified external sphincterotomy, there was a significant reduction in the dysreflexic response during cystomanometry of the bladder (CMG). The potential of a significant rise in blood pressure during CMG makes it necessary to monitor blood pressure during these studies and be prepared to expediently deflate the bladder to prevent an inordinate rise in blood pressure, preventing cerebral vascular complications. Patients with a significant rise in blood pressure during CMG are at risk for severe dysreflexia when their bladder is full and require management strategies to optimize control of blood pressure response with medication and/or transurethral surgery.