Etiology

Almost any precipitant below the neurologic lesion can trigger autonomic dysreflexia. Important to the urologist, a genitourinary cause is responsible in 81 %-87% of cases (Shergill et al. 2004). The commonest reason for autonomic dysreflexia is bladder distension, ac counting for 75%-85% of cases (Blackmer 2003). Bladder distension can be a consequence of a kinked or obstructed catheter as well as an insufficient intermittent catheterization frequency. Other urinary triggers are infection, instrumentation, stones, and urethral distension.

As almost 90 % of cases have a genitourinary cause, it is particularly important for the urologist to prevent autonomic dysreflexia. When treating patients with SCI, the urologist should be aware of the possibility of autonomic dysreflexia. When performing instrumentation of the lower urinary tract, for example changing a catheter, local anesthetic jelly and an aseptic technique (to avoid urinary tract infection as a precipitant of autonomic dysreflexia) should be used. If the instrumentation takes more than a few minutes (cystoscopy, urodynamic investigation) sufficient blood pressure monitoring should also be provided. It should also be noted that even sexual intercourse can effect autonomic dysreflexia. Therefore the andrologist should keep in mind this risk when applying vibroejaculation to a SCI patient.

The second most common precipitant for autonom-ic dysreflexia is bowel distension (13 % -19 % of cases).

Table 9.1 displays precipitants for autonomic dysref-lexia.

Table 9.1. Precipitants for autonomic dysreflexia

Urological

Bladder distension (kinked/obstructed catheter)

Infection

Urethral distension

Instrumentation (indwelling catheter, cystos

copy, urodynamics)

Stones

Ejaculation (vibro- or electroejaculation)

Sexual intercourse

Gastro

Bowel distension (fecal impaction)

intestinal

Instrumentation

Infection or inflammation (colitis, peritonitis)

Gastric ulcer

Reflux

Hemorrhoids

Anal fissure

Dermato-

Pressure sore

logic

Ingrown toenail

Burns (sunburns, burns from hot water)

Tight clothing or pressure to skin

Skeletal

Heterotopic ossification

Fracture

Joint dislocation

Repro

Labor and delivery

ductive

Menstruation

Testicular torsion

Hemato-

Deep vein thrombosis

logic

Pulmonary embolism

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