AUTONOMIC HYPERREFLEXIA REVISITED

Purpose: To analyze autonomic hyperreflexia (AHR) associated with neur ogenic bladder dysfunction in high spinal cord-injured patients, Mater ial and Methods: Sixty-five patients were examined using a new recordi ng system, Seventeen suffered from a spinal cord lesion above the T5-T 6 level and presented with neurogenic voiding disorders and AHR, Mean arterial pressure (MAP) changes were analyzed during 3 different urody namic phases: bladder filling; isometric bladder contraction, and void ing, Results: Of the 17 tetraplegic and high paraplegic patients, 6 dr opped out and 11 entered the study, Nine of these eleven patients disp layed uninhibited bladder contractions and voiding, In these 9 cases M AP increased progressively during bladder contraction until a maximal bladder pressure was reached, An ongoing elevation of MAP was observed during voiding which returned to normal values within 5 min after mic turition, In 2 patients detrusor-sphincter dyssynergia prevented voidi ng, As opposed to the 9 previously mentioned patients, maximal MAP occ urred at or before the maximal bladder pressure in these 2 cases and d ecreased thereafter, Conclusions: Evidence is presented that the poste rior urethral receptors and their ascending pathway played a major rol e in the maintenance of AHR during micturition.