Flawed trial of micturition in cervical spinal cord injury patients: guidelines for trial of voiding in men with tetraplegia

Vaidyanathan, S; Soni, B M; Sett, P; Singh, G.; Oo, Tun; Hughes, Peter L; Mansour, Paul

doi:10.1038/sj.sc.3101519

Cited by 5 publications

(7 citation statements)

References 17 publications

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“…8). However, high pressure voiding is not clinically useful since it could cause autonomic dysreflexia and kidney problems in long-term application (10,44). In contrast, mechanical stimulation of the perigenital region is utilized by the mother cats to completely empty the bladder of neonatal kittens indicating that coactivation of the urethral sphincter is probably not induced in the neonates.…”

Section: Discussionmentioning

confidence: 95%

Inhibitory and excitatory perigenital-to-bladder spinal reflexes in the cat

Tai¹,

Shen²,

Wang³

et al. 2008

American Journal of Physiology-Renal Physiology

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This study revealed that in awake chronic spinal cord-injured (SCI) cats reflexes from perigenital skin area to the bladder can be either inhibitory or excitatory. Electrical perigenital stimulation at frequencies between 5 and 7 Hz significantly inhibited large-amplitude rhythmic reflex bladder activity, whereas frequencies between 20 and 40 Hz induced large-amplitude bladder contractions even at low bladder volumes when reflex bladder activity was absent. Both inhibitory and excitatory effects were enhanced as the stimulation intensity increased (5-30 V, 0.2-ms pulse width). During cystometrograms, the inhibitory stimulation (7 Hz) significantly increased the micturition volume threshold 35 Ϯ 13% above the control volume, while the excitatory stimulation (30 Hz) significantly reduced the threshold 21 Ϯ 3%. Mechanical perigenital stimulation applied by repeated light stroking of the perigenital skin with a cotton swab only induced an excitatory effect on the bladder. Both electrical and mechanical perigenital stimuli induced large-amplitude (Ͼ30 cmH 2O) bladder contractions that were relatively consistent over a range of bladder volumes (10 -90% of the capacity). However, the excitatory electrical stimulation only induced bladder contractions lasting on average 42.2 Ϯ 3.9 s, but the mechanical stimulation induced bladder contractions that lasted as long as the stimulation continued (2-3 min). Excitatory electrical or mechanical perigenital stimulation also induced poststimulus voiding. The ability to either inhibit or excite the bladder by noninvasive methods could significantly transform the current clinical management of bladder function after SCI. urinary bladder; electrical stimulation; spinal cord injury AFTER SPINAL CORD INJURY (SCI) incontinence occurs frequently due to detrusor overactivity. Meanwhile, the bladder also does not empty well due to detrusor sphincter dyssynergia resulting in a large residual volume of urine. Thus, the management of bladder function after SCI is a challenging task, because it requires inhibition of detrusor overactivity during urine storage and induction of a large-amplitude bladder contraction to empty the bladder (3). Current treatment for bladder dysfunction after SCI has either limited success (49) or requires major invasive spinal surgery to implant stimulating electrodes on spinal roots (6). Intermittent urethral catheterization is the most common method for managing urinary tract dysfunction (10). However, it can lead to frequent bladder infections (25).In this study in chronic paraplegic cats, we evaluated an alternative method to regulate bladder function involving electrical stimulation of somatic afferent nerves innervating the perigenital region. Perigenital-to-bladder reflexes undergo marked changes during postnatal development and after SCI. In neonatal kittens before the spinobulbospinal micturition reflex is fully developed, the bladder is emptied by the mother cat periodically licking the skin in the perigenital area of the kitten to induce a bladder contra...

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Section: Discussionmentioning

confidence: 95%

Inhibitory and excitatory perigenital-to-bladder spinal reflexes in the cat

Tai¹,

Shen²,

Wang³

et al. 2008

American Journal of Physiology-Renal Physiology

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“…31 Other iatrogenic urological triggers of AD are mostly related to bladder distension where catheterization is the leading choice for management. 59,60 If, however, AD is not managed after catheterization, antihypertensive drugs should be considered. 60 …”

Section: Discussionmentioning

confidence: 99%

“…59,60 If, however, AD is not managed after catheterization, antihypertensive drugs should be considered. 60 …”

Section: Discussionmentioning

confidence: 99%

“…Barbaric et al 59 reported two individuals with BP elevation during cystourethrography and loopography, respectively. Vaidyanathan et al 60 found that two individuals developed AD during micturition trial 2-3 h after the removal of the urethral catheter. In fact, the nature of these triggers is still related to bladder distension.…”

Section: Other Iatrogenic Urological Triggersmentioning

confidence: 99%

“…In fact, the nature of these triggers is still related to bladder distension. Vaidyanathan et al 60 also used nifedipine 10 mg sublingually to treat the AD.…”

Section: Other Iatrogenic Urological Triggersmentioning

confidence: 99%

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Iatrogenic urological triggers of autonomic dysreflexia: a systematic review

et al. 2015

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Study design: This is a systematic review. Objective: The objective of this study was to review the literature on iatrogenic urological triggers of autonomic dysreflexia (AD). Setting: 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. Conclusion: 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.

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