Autonomic dysreflexia during urodynamics: A systematic review of incidence and predictors

Objectives

Urodynamic investigation is a mainstay in assessment of lower urinary tract dysfunction in spinal cord injury (SCI). However, like with many forms of urological intervention in the SCI cohort – it carries a risk of autonomic dysreflexia (AD). This systematic review aims to ascertain the incidence and predictors of autonomic dysreflexia during urodynamic investigation, in those with SCI.

Methods

Systematic review was conducted according to PRISMA guidelines, and prospectively registered on PROSPERO (ID CRD420251000507). Ovid MEDLINE, Embase, Web of Science Core Collection and CINAHL databases were searched.

Results

Of total 2098 articles screened, 21 were ultimately included for systematic review. Of the 21 included studies, 13 reported incidence of AD during urodynamics, with reported incidence varyingly broadly from 7.9 to 90.9 %. In studies reporting SCI above T6 specifically, incidence of AD during urodynamics varied from 42.5 to 83.7 %, while in studies reporting incidence in SCI below T6, incidence varied from 5.9 to 82.3 %. There was heterogeneity in results regarding predictors of AD during urodynamics: level of injury was generally predictive of AD incidence, completeness of injury and patient age did not predict AD incidence but did potentially predict severity, and data regarding urodynamic predictors (detrusor overactivity, detrusor-sphincter dyssynergia, compliance, detrusor pressures) was conflicting. Several studies had high proportion of silent/asymptomatic AD (38–63 %), hence some authors suggested continuous/beat-to-beat cardiac monitoring during urodynamics in SCI patients to allow early identification and intervention for AD.

Conclusion

This systematic review identified the incidence of AD during urodynamics in SCI to be high, although results regarding predictors of AD were variable. Clinicians should consider continuous cardiac monitoring during urodynamics in at-risk SCI patients, and remain vigilant to risk of AD in SCI below T6. Future studies should aim to adopt a universal definition of AD and be prospective, to permit statistical synthesis and meta-analysis to conclusively define predictors of AD during urodynamics.