Autonomic dysreflexia (AD) and urology

Aim. - To summarize pathophysiology, diagnosis, treatment and prevention of autonomic dysreflexia (AD) in the field of urology. Methods. - Short review of the literature via Pub Med matching terms "AD" and "urology" "summary" and "synthesis" by two practitioners (urology and rehabilitation medicine). Results. - Spinal cord injury above the sixth thoracic level (T6) implies autonomic imbalance and the risk of sympathetic discharge induced by a nociceptive stimulation below lesion level, potentially with severe complications. Urological stimuli are frequently the triggering factors in this population with a high urinary complication rate, so that cautions must take place. Primary preventative strategies consist in the control of nociceptive afferent stimuli even if a complete lesion remains: anesthesia (preferably local regional) must be done in case of therapeutic procedure, or for diagnostic procedure (local anesthesia, except for urodynamic) if a history of severe AD exists. Bladder distension must be reduced to necessary. In acute AD, non-pharmacological strategies must be employed initially (up-right position, secondary prevention). When these actions fail and blood pressure is still at or above 150 mmHg in an adult (less in a child), pharmacological agents are required and nifedipine and captopril are the most commonly used and evidence-based agents. Conclusion. - Since almost all spinal cord injured patients need urological care, and urological diagnostic or therapeutic interventions can trigger AD, this specific and potentially life threatening condition has to be known by urologist. (C) 2013 Published by Elsevier Masson SAS.