SILENT AUTONOMIC DYSREFLEXIA DURING VOIDING IN MEN WITH SPINAL-CORD INJURIES

Purpose: We determined whether symptoms of autonomic dysreflexia corre lated with elevations in blood pressure in men with spinal cord injuri es. Materials and Methods: During a routine yearly urodynamic evaluati on 45 consecutive men with complete spinal cord injuries above T6 unde rwent simultaneous monitoring of blood pressure and symptoms of autono mic dysreflexia. Those with systolic blood pressure of greater than 16 0 mm. Hg or diastolic blood pressure of greater than 90 mm. Hg during voiding were assigned to the hypertensive group. During voiding 35 men (78%) had significant hypertension. Results: Before voiding there was no statistical difference in mean systolic blood pressure between men with and without hypertension (117 versus 110 mm. Hg, p = 0.28). Duri ng uninhibited contractions and voiding mean systolic blood pressure o f the normotensive group (131 mm. Hg) versus the hypertensive group (1 69 mm. Hg) was statistically significant (p <0.0001). Of the 35 hypert ensive patients 15 (43%) had no symptoms of autonomic dysreflexia. The re was no correlation of autonomic dysreflexia with length of injury, maximum voiding pressure or bladder capacity (p = 0.59, 0.85 and 0.34, respectively). Conclusions: Urodynamics are helpful to detect symptom atic and asymptomatic autonomic dysreflexia. Significant elevations in blood pressure can occur without the symptoms of autonomic dysreflexi a.