ABSTRACT
Autonomic dysreflexia (AD) occurs in approximately 60% of patients with cervical spinal cord injury (SCI) and 20% of patients with thoracic SCI. The most common stimulus for AD is stimulation of the urethra/prostate/internal sphincter region or distention of the bladder or rectum, with the former being a much more potent stimulus. AD is classically characterized by an increase in blood pressure, which can occur suddenly, accompanied by bradycardia. Symptoms of AD usually start after the spinal shock period. AD in the patient with SCI generally occurs after the spinal shock phase of approximately 6–12 weeks. Urologists can play an important role in AD prevention since the primary driver of AD episodes is lower urinary tract stimulation. They can educate all patients on the importance of avoiding bladder overdistention either from infrequent catheterizations or from indwelling catheter kinking or clogging. Urologists also frequently perform lower urinary tract procedures in the office on this patient population, and they can trigger AD episodes.
