Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

Characterization of heart rate changes associated with autonomic dysreflexia during penile vibrostimulation and urodynamics

Abstract

Study design

Secondary data analysis.

Objectives

To characterize autonomic dysreflexia (AD) associated heart rate (HR) changes during penile vibrostimulation (PVS) and urodynamic studies (UDS).

Setting

University-based laboratory.

Methods

We analyzed blood pressure (BP) and HR data, recorded continuously, from 21 individuals (4 females; median age 41 years [lower and upper quartile, 37; 47]; median time post-injury 18 years [7; 27]; all motor-complete spinal cord injury (SCI) except one; cervical SCI = 15, thoracic [T1–T6] SCI = 6), who underwent PVS (11/21) or UDS (10/21).

Results

Overall, 47 AD episodes were recorded (i.e. PVS = 37, UDS = 10), with at least one AD episode in each participant. At AD threshold, bradycardia was observed during PVS and UDS in 43% and 30%, respectively. At AD peak (i.e., maximum increase in systolic BP from baseline), bradycardia was observed during PVS and UDS in 65% and 50%, respectively. Tachycardia was detected at AD peak only once during UDS. Our study was limited by a small cohort of participants and the distribution of sex and injury characteristics.

Conclusions

Our findings reveal that AD-associated HR changes during PVS and UDS appear to be related to the magnitude of systolic BP increases. Highly elevated systolic BP associated with bradycardia suggests the presence of severe AD. Therefore, we recommend cardiovascular monitoring (preferably with continuous beat-to-beat recordings) during PVS and UDS to detect AD early. Stopping assessments before systolic BP reaches dangerously elevated levels, could reduce the risk of life-threatening complications in this cohort.

This is a preview of subscription content, access via your institution

Access options

Buy article

Get time limited or full article access on ReadCube.

$32.00

All prices are NET prices.

Fig. 1: Study flow diagram.
Fig. 2: Cardiovascular changes during PVS.
Fig. 3: Cardiovascular changes during UDS.

Data availability

The datasets generated and/or analysed during the current study are available from the corresponding author on reasonable request.

References

  1. McKinley WO, Jackson AB, Cardenas DD, DeVivo MJ. Long-term medical complications after traumatic spinal cord injury: A Regional Model Systems Analysis. Arch Phys Med Rehabil. 1999;80:1402–10.

    CAS  Article  Google Scholar 

  2. Karlsson AK. Autonomic dysreflexia. Spinal Cord. 1999;37:383–91.

    CAS  Article  Google Scholar 

  3. Lee ES, Joo MC. Prevalence of autonomic dysreflexia in patients with spinal cord injury above T6. Biomed Res Int. 2017;37:2–10.

    Google Scholar 

  4. Wan D, Krassioukov AV. Life-threatening outcomes associated with autonomic dysreflexia: A clinical review. J Spinal Cord Med. 2014;37:2–10.

    Article  Google Scholar 

  5. DeVivo MJ, Krause JS, Lammertse DP. Recent trends in mortality and causes of death among persons with spinal cord injury. Arch Phys Med Rehabil. 1999;80:1411–9.

    CAS  Article  Google Scholar 

  6. Curt A, Nitsche B, Rodic B, Schurch B, Dietz V. Assessment of autonomic dysreflexia in patients with spinal cord injury. J Neurol Neurosurg Psychiatry. 1997;62:473–7.

    CAS  Article  Google Scholar 

  7. Noonan VK, Fingas M, Farry A, Baxter D, Singh A, Fehlings MG, et al. Incidence and prevalence of spinal cord injury in Canada: A national perspective. Neuroepidemiology 2012;38:219–26.

    Article  Google Scholar 

  8. Walter M, Knüpfer SC, Cragg JJ, Leitner L, Schneider MP, Mehnert U, et al. Prediction of autonomic dysreflexia during urodynamics: A prospective cohort study. BMC Med. 2018;16:53.

    Article  Google Scholar 

  9. Sheel AW, Krassioukov AV, Inglis JT, Elliott SL. Autonomic dysreflexia during sperm retrieval in spinal cord injury: Influence of lesion level and sildenafil citrate. J Appl Physiol. 2005;99:53–8.

    Article  Google Scholar 

  10. Davidson R, Elliott S, Krassioukov A. Cardiovascular responses to sexual activity in able-bodied individuals and those living with spinal cord injury. J Neurotrauma. 2016;33:2161–74.

    Article  Google Scholar 

  11. Groen J, Pannek J, Castro Diaz D, Del Popolo G, Gross T, Hamid R, et al. Summary of European Association of Urology (EAU) guidelines on neuro-urology. Eur Urol. 2016;69:324–33.

    Article  Google Scholar 

  12. Claydon VE, Elliott SL, Sheel AW, Krassioukov A. Cardiovascular responses to vibrostimulation for sperm retrieval in men with spinal cord injury. J Spinal Cord Med. 2006;29:207–16.

    Article  Google Scholar 

  13. Huang YH, Bih LI, Liao JM, Chen SL, Chou LW, Lin PH. Blood pressure and age associated with silent autonomic dysreflexia during urodynamic examinations in patients with spinal cord injury. Spinal Cord. 2013;51:401–5.

    Article  Google Scholar 

  14. Maiorov DN, Fehlings MG, Krassioukov A. Relationship between severity of spinal cord injury and abnormalities in neurogenic cardiovascular control in conscious rats. J Neurotrauma. 1998;15:365–74.

    CAS  Article  Google Scholar 

  15. Ekland MB, Krassioukov A, McBride KE, Elliott SL. Incidence of autonomic dysreflexia and silent autonomic dysreflexia in men with spinal cord injury undergoing sperm retrieval: Implications for clinical practice. J Spinal Cord Med. 2008;31:33–9.

    Article  Google Scholar 

  16. Solinsky R, Kirshblum SC, Burns SP. Exploring detailed characteristics of autonomic dysreflexia. J Spinal Cord Med. 2018;41:549–55.

    Article  Google Scholar 

  17. Hiekey KJ, Vogel LC, Willis KM, Anderson CJ. Prevalence and etiology of autonomic dysreflexia in children with spinal cord injuries. J Spinal Cord Med. 2004;27:54–60.

    Article  Google Scholar 

  18. Kewalramani LS. Autonomic dysreflexia in traumatic myelopathy. Am J Phys Med. 1980;59:1–21.

    CAS  PubMed  Google Scholar 

  19. Krassioukov A, Warburton DE, Teasell R, Eng JJ. A systematic review of the management of autonomic dysreflexia after spinal cord injury. Arch Physical Med Rehab. 2009;90:682–95.

  20. Kirshblum SC, Burns SP, Biering-Sorensen F, Donovan W, Graves DE, Jha A, et al. International standards for neurological classification of spinal cord injury. J Spinal Cord Med. 2011;34:535–46.

    Article  Google Scholar 

  21. Krassioukov A, Biering-Sorensen F, Donovan W, Kennelly M, Kirshblum S, Krogh K, et al. International standards to document remaining autonomic function after spinal cord injury. Spinal Cord. 2012;35:201–10.

    Article  Google Scholar 

  22. Phillips AA, Matin N, Jia M, Squair JW, Monga A, Zheng MMZ, et al. Transient Hypertension after Spinal Cord Injury Leads to Cerebrovascular Endothelial Dysfunction and Fibrosis. J Neurotrauma. 2018;35:573–81.

    Article  Google Scholar 

  23. Abrams P, Cardozo L, Fall M, Griffiths D, Rosier P, Ulmsten U, et al. The standardisation of terminology of lower urinary tract function: Report from the standardisation sub-committee of the international continence society. Am J Obstet Gynecol. 2002;187:116–26.

    Article  Google Scholar 

  24. Naftchi N. Mechanism of autonomic Dysreflexia. Ann N. Y Acad Sci. 1990;579:133–48.

    CAS  Article  Google Scholar 

  25. Hector SM, Biering-Sørensen T, Krassioukov A, Biering-Sørensen F. Cardiac arrhythmias associated with spinal cord injury. J Spinal Cord Med. 2013;36:591–9.

    Article  Google Scholar 

  26. Collins HL, Rodenbaugh DW, DiCarlo SE. Spinal cord injury alters cardiac electrophysiology and increases the susceptibility to ventricular arrhythmias. Prog Brain Res. 2006;152:275–88.

    Article  Google Scholar 

  27. West CR, Bellantoni A, Krassioukov AV. Cardiovascular function in individuals with incomplete spinal cord injury: A systematic review. Top Spinal Cord Inj Rehabil. 2013;19:267–78.

    Article  Google Scholar 

  28. Vírseda-Chamorro M, Salinas-Casado J, Gutiérrez-Martín P, de la Marta-García M, López-García-Moreno A, Esteban Fuertes M. Risk factors to develop autonomic dysreflexia during urodynamic examinations in patients with spinal cord injury. Neurourol Urodyn. 2017;36:171–5.

    Article  Google Scholar 

  29. Linsenmeyer TA, Gibbs K, Solinsky R. Autonomic Dysreflexia after spinal cord. Injury: Beyond Basics Curr Phys Med Rehabil Rep. 2020;8:443–51.

    Google Scholar 

  30. Linsenmeyer TA, Campagnolo DI, Chou IH. Silent autonomic dysreflexia during voiding in men with spinal cord injuries. J Urol. 1996;155:519–22.

    CAS  Article  Google Scholar 

Download references

Acknowledgements

We wish to acknowledge our colleagues at the Blusson Spinal Cord Centre. Furthermore, we would like to thank the participants who provided written informed consent for participation and publication in this study.

Funding

This study was funded by the Rick Hansen Man in Motion Research Foundation (grant number: 135774, awarded to Dr. Krassioukov). The research equipment for this study was supported by the Canadian Foundation of Innovation (CFI, grant number: 35869) and the British Columbia Knowledge Development Fund (BCKDF, grant number: 35869. Dr. Walter was supported by a 2017–2019 Michael Smith Foundation for Health Research (MSFHR) and Rick Hansen Foundation Postdoctoral Research Trainee Award (grant number 17110). Dr. Krassioukov holds the Endowed Chair in Rehabilitation Medicine.

Author information

Authors and Affiliations

Authors

Contributions

LR: Study conception and design, acquisition and interpretation of data, statistical analysis, drafting of the manuscript and critical revisions. ALR: Acquisition and interpretation of data, and critical revision of the manuscript for important intellectual content. SH: Acquisition and interpretation of data, and critical revision of the manuscript for important intellectual content. SE: Study conception and design, acquisition and interpretation of data, and critical revision of the manuscript for important intellectual content. MW: Study conception and design, acquisition and interpretation of data, statistical analysis, and critical revision of the manuscript for important intellectual content and supervision. AVK: Study conception and design, acquisition and interpretation of data, critical revisions and critical revision of the manuscript for important intellectual content and supervision. All authors approve the final version to be published and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding authors

Correspondence to Matthias Walter or Andrei V. Krassioukov.

Ethics declarations

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

Rights and permissions

Springer Nature or its licensor holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Rietchel, L., Ramirez, A.L., Hocaloski, S. et al. Characterization of heart rate changes associated with autonomic dysreflexia during penile vibrostimulation and urodynamics. Spinal Cord (2022). https://doi.org/10.1038/s41393-022-00843-5

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1038/s41393-022-00843-5

Search

Quick links