urovestВестник урологииUrology Herald2308-6424Rostov State Medical University10.21886/2308-6424-2022-10-4-43-53urovest-624Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИORIGINAL ARTICLESОценка риска развития автономной дисрефлексии при комплексном уродинамическом исследовании у пациентов после травмы спинного мозгаThe risk of developing autonomic dysreflexia during urodynamic testing in patients after spinal cord injuryhttps://orcid.org/0000-0003-4251-7545КамаловА. А.KamalovA. A.

Камалов Армаис Альбертович — доктор медицинских наук, профессор, академик РАН, директор медицинского научно-образовательного центра, заведующий кафедрой урологии и андрологии факультета фундаментальной медицины МГУ им. М.В. Ломоносова.

119991, Москва, Ленинские горы, д. 1

Armais A. Kamalov — M.D., Dr.Sc.(Med), Full Prof., Acad. of the RAS, Head, Dept. of Urology and Andrology, Faculty of Fundamental Medicine, Lomonosov Moscow State University; Headmaster, Medical Research and Educational Centre, Lomonosov Moscow State University.

1 Leninskie Gory, Moscow, 119991

priemnaya@mc.msu.ruhttps://orcid.org/0000-0002-6768-9004ОхоботовД. А.OkhobotovD. A.

Охоботов Дмитрий Александрович — кандидат медицинских наук, доцент кафедры урологии и андрологии факультета фундаментальной медицины, врач-уролог медицинского научно-образовательного центра МГУ им. М.В. Ломоносова.

119991, Москва, Ленинские горы, д. 1

Dmitry A. Ohobotov — M.D. Cand.Sc.(Med), Assoc.Prof. (Docent), Dept. of Urology and Andrology, Faculty of Fundamental Medicine, Lomonosov Moscow State University; Urologist, Medical Research and Education Center, Lomonosov Moscow State University.

1 Leninskie Gory, Moscow, 119991

14072003@rambler.ruhttps://orcid.org/0000-0003-1736-9085ЧалыйМ. Е.ChalyM. E.

Чалый Михаил Евгеньевич — доктор медицинских наук, профессор, ведущий научный сотрудник медицинского научно-образовательного центра МГУ им. М.В. Ломоносова.

119991, Москва, Ленинские горы, д. 1

Mikhail E. Chaliy — M.D., Dr.Sc.(Med), Full Prof., Leading Researcher, Medical Research and Education Center, Lomonosov Moscow State University.

1 Leninskie Gory, Moscow, 119991

chalyy@bk.ruhttps://orcid.org/0000-0002-5198-288XФроловаМ. В.FrolovaM. V.

Фролова Мария Валерьевна — аспирант кафедры урологии и андрологии факультета фундаментальной медицины МГУ им. М.В. Ломоносова.

119991, Москва, Ленинские горы, д. 1

Maria V. Frolova — M.D., Postgrad. Student, Dept. of Urology and Andrology, Faculty of Fundamental Medicine, Lomonosov Moscow State University.

1 Leninskie Gory, Moscow, 119991

mary.froloy@yandex.ruhttps://orcid.org/0000-0002-5405-603XХуторнойИ. В.KhutoroiI. V.

Хуторной Иван Валерьевич — аспирант кафедры общей и специализированной хирургии факультета фундаментальной медицины МГУ им. М.В. Ломоносова.

119991, Москва, Ленинские горы, д. 1

Ivan V. Khutornoy — M.D., Postgrad. Student, Dept. of General and Advanced Surgery, Faculty of Fundamental Medicine, Lomonosov Moscow State University.

1 Leninskie Gory, Moscow, 119991

mcdm.avk@gmail.comhttps://orcid.org/0000-0002-7128-6400СалюковР. В.SalyukovR. V.

Салюков Роман Вячеславович — кандидат медицинских наук, доцент кафедры эндоскопической урологии и ультразвуковой диагностики РУДН.

117198, Москва, ул. Миклухо-Маклая, д. 6

Roman V. Salyukov — M.D., Cand.Sc.(Med), Assoc.Prof. (Docent), Dept. of Endoscopic Urology and Ultrasound Diagnostics, Faculty of Continuing Medical Education, Peoples’ Friendship University of Russia (RUND University).

6 Miklukho-Maklay St., Moscow, 117198

salyukov2012@yandex.ruМосковский государственный университет имени М.В. ЛомоносоваРоссияLomonosov Moscow State University (Lomonosov University)Russian FederationРоссийский университет дружбы народовРоссияPeoples' Friendship University of Russia (RUDN University)Russian Federation2022261220221044353Copyright © Камалов А.А., Охоботов Д.А., Чалый М.Е., Фролова М.В., Хуторной И.В., Салюков Р.В., 20232023Камалов А.А., Охоботов Д.А., Чалый М.Е., Фролова М.В., Хуторной И.В., Салюков Р.В.Kamalov A.A., Okhobotov D.A., Chaly M.E., Frolova M.V., Khutoroi I.V., Salyukov R.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.urovest.ru/jour/article/view/624Введение

Введение. Автономная дисрефлексия (АвтД) является опасным, жизнеугрожающим состоянием у пациентов с травмой спинного мозга (ТСМ) выше уровня T6 сегмента. АвтД может привести к ряду сердечно-сосудистых катастроф — инфаркту миокарда, острому нарушению мозгового кровообращения вплоть до летального исхода. В настоящее время алгоритма диагностики и определение факторов риска возникновения АвтД не существует.

Цель исследования

Цель исследования. Определить наиболее информативные диагностические критерии автономной дисрефлексии  у пациентов, перенёсших травму спинного мозга.

Материалы и методы

Материалы и методы. Включено 40 пациентов с ТСМ выше сегмента T6. По степени повреждения спинного мозга выделено две группы. В группу 1 (n = 14) вошли пациенты с полным повреждением спинного мозга, соответствующие категории А по шкале ASIA, в группу 2 — с неполным повреждением спинного мозга, классифицированные как ASIA – B, C, D (n = 26). Для оценки факторов риска развития АвтД применяли опросник ADFSCI, затем проводили уродинамическое исследование с одномоментной регистрацией артериального давления и частоты сердечных сокращений (ЧСС), что подтверждало или опровергало наличие АвтД у пациентов.

Результаты

Результаты. Согласно опроснику ADFSCI, у большинства пациентов была установлена высокая степень тяжести вегетативных нарушений, что позволило предположить наличие АвтД. Впоследствии это предположение подтвердилось результатами уродинамического исследования с одновременным мониторингом систолического и диастолического артериального давления (САД и ДАД), а также ЧСС. При сравнении групп были обнаружены значимые различия по параметрам опросника ADFSCI, а также по показателям САД и ДАД (в точках максимального детрузорного давления и при достижении цистометрической ёмкости).

Заключение

Заключение. Результаты исследования позволяют сделать выводы о высокой встречаемости АвтД у пациентов с ТСМ выше сегмента Т6 и необходимости предварительной оценки рисков развития данного состояния на основе опросника ADFSCI, в частности, перед проведением уродинамического исследования. С учётом возможных осложнений АвтД проведение уродинамического исследования должно сопровождаться непрерывным мониторингом показателей сердечно-сосудистой системы.

Introduction

Introduction. Autonomic dysreflexia (AD) is a life-threatening dangerous condition in patients with spinal cord injury (SCI) above the T6 segment level. It is characterized by a sudden rise in systolic blood pressure more than 20 mmHg, and unpredictable reactions from the autonomic nervous system. An episode of autonomic dysreflexia can lead to several cardiovascular catastrophes – heart attack and/or acute cerebrovascular accident up to a lethal outcome. Currently, there is no diagnostic algorithm and no way to determine risk factors for the occurrence of autonomic dysreflexia.

Objective

Objective. To search for the most informative diagnostic criteria for autonomic dysreflexia in patients with spinal cord injury.

Materials and methods

Materials and methods. The study included 40 patients with SCI above the T6 segment. Depending on the SCI degree, two groups were distinguished. Group 1 (n = 14) included patients with complete spinal cord injury, advising category A on the ASIA scale. Group 2 (n = 26) included patients with incomplete spinal cord injury, classified as ASIA-B, C, D. For a preliminary assessment of the risk factors for the development of AD, an ADFSCI questionnaire was used, then a urodynamic study was conducted with simultaneous registration of systolic / diastolic blood pressure (SBP / DBP), and heart rate, which confirmed or denied the presence of AD in patients.

Results

Results. According to the ADFSCI questionnaire, most patients showed a high degree of severity of autonomic disorders, suggesting the presence of AD. Subsequently, this assumption was confirmed by the results of a urodynamic testing with simultaneous monitoring of SBP / DBP and heart rate. When comparing the groups, statistically significant differences were found in the parameters of the ADFSCI questionnaire, as well as in the indicators of SBP / DBP (at the points of maximum detrusor pressure and when the cystometric capacity is reached).

Conclusion

Conclusion. The obtained results allow us to draw conclusions about the high incidence of AD in patients with SCI above the T6 segment and the need for a preliminary assessment of the risks of developing this condition based on the ADFSCI questionnaire before conducting a urodynamic study. Considering the possible complications of AD, the urodynamic testing should be accompanied by continuous monitoring of the indicators of the cardiovascular system.

автономная дисрефлексиятравма спинного мозганейрогенный мочевой пузырьautonomic dysreflexiaspinal cord injuryneurogenic bladderReferencesBickenbach J, Officer A, Shakespeare T, von Groote P, eds. International Perspectives on Spinal Cord Injury. World Health Organization; 2013. ISBN: 978-92-4-156466-3. URL: https://apps.who.int/iris/handle/10665/94190Bickenbach J, Officer A, Shakespeare T, von Groote P, eds. International Perspectives on Spinal Cord Injury. World Health Organization; 2013. ISBN: 978-92-4-156466-3. URL: https://apps.who.int/iris/handle/10665/94190Barbiellini Amidei C, Salmaso L, Bellio S, Saia M. Epidemiology of traumatic spinal cord injury: a large population-based study. Spinal Cord. 2022;60(9):812-819. https://doi.org/10.1038/s41393-022-00795-wBarbiellini Amidei C, Salmaso L, Bellio S, Saia M. Epidemiology of traumatic spinal cord injury: a large population-based study. Spinal Cord. 2022;60(9):812-819. https://doi.org/10.1038/s41393-022-00795-wНовоселова И.Н. Этиология и клиническая эпидемиология позвоночно-спинномозговой травмы. Литературный обзор. Российский нейрохирургический журнал им. профессора А.Л. Поленова. 2019;11(4):84-92. EDN: MGTZJDNovoselova I.N. Etiology and clinical epidemiology of spinal cord injury. Literature review. Russian neurosurgical journal named after professor A.L. Polenov. 2019;11(4):84-92. (In. Russ) EDN: MGTZJDPanicker JN, Fowler CJ, Kessler TM. Lower urinary tract dysfunction in the neurological patient: clinical assessment and management. Lancet Neurol. 2015;14(7):720-32. https://doi.org/10.1016/S1474-4422(15)00070-8Panicker JN, Fowler CJ, Kessler TM. Lower urinary tract dysfunction in the neurological patient: clinical assessment and management. Lancet Neurol. 2015;14(7):720-32. https://doi.org/10.1016/S1474-4422(15)00070-8Furlan JC, Fehlings MG. Cardiovascular complications after acute spinal cord injury: pathophysiology, diagnosis, and management. Neurosurg Focus. 2008;25(5):E13. https://doi.org/10.3171/FOC.2008.25.11.E13Furlan JC, Fehlings MG. Cardiovascular complications after acute spinal cord injury: pathophysiology, diagnosis, and management. Neurosurg Focus. 2008;25(5):E13. https://doi.org/10.3171/FOC.2008.25.11.E13Karlsson AK. Autonomic dysreflexia. Spinal Cord. 1999;37(6):383-91. https://doi.org/10.1038/sj.sc.3100867Karlsson AK. Autonomic dysreflexia. Spinal Cord. 1999;37(6):383-91. https://doi.org/10.1038/sj.sc.3100867Cragg JJ, Noonan VK, Dvorak M, Krassioukov A, Mancini GB, Borisoff JF. Spinal cord injury and type 2 diabetes: results from a population health survey. Neurology. 2013;81(21):1864-8. https://doi.org/10.1212/01.wnl.0000436074.98534.6eCragg JJ, Noonan VK, Dvorak M, Krassioukov A, Mancini GB, Borisoff JF. Spinal cord injury and type 2 diabetes: results from a population health survey. Neurology. 2013;81(21):1864-8. https://doi.org/10.1212/01.wnl.0000436074.98534.6eGarshick E, Kelley A, Cohen SA, Garrison A, Tun CG, Gagnon D, Brown R. A prospective assessment of mortality in chronic spinal cord injury. Spinal Cord. 2005;43(7):408-16. https://doi.org/10.1038/sj.sc.3101729Garshick E, Kelley A, Cohen SA, Garrison A, Tun CG, Gagnon D, Brown R. A prospective assessment of mortality in chronic spinal cord injury. Spinal Cord. 2005;43(7):408-16. https://doi.org/10.1038/sj.sc.3101729Myers J, Lee M, Kiratli J. Cardiovascular disease in spinal cord injury: an overview of prevalence, risk, evaluation, and management. Am J Phys Med Rehabil. 2007;86(2):142-52. https://doi.org/10.1097/PHM.0b013e31802f0247Myers J, Lee M, Kiratli J. Cardiovascular disease in spinal cord injury: an overview of prevalence, risk, evaluation, and management. Am J Phys Med Rehabil. 2007;86(2):142-52. https://doi.org/10.1097/PHM.0b013e31802f0247Sabre L, Rekand T, Asser T, Kõrv J. Mortality and causes of death after traumatic spinal cord injury in Estonia. J Spinal Cord Med. 2013;36(6):687-94. https://doi.org/10.1179/2045772313Y.0000000120Sabre L, Rekand T, Asser T, Kõrv J. Mortality and causes of death after traumatic spinal cord injury in Estonia. J Spinal Cord Med. 2013;36(6):687-94. https://doi.org/10.1179/2045772313Y.0000000120Wan D, Krassioukov AV. Life-threatening outcomes associated with autonomic dysreflexia: a clinical review. J Spinal Cord Med. 2014;37(1):2-10. https://doi.org/10.1179/2045772313Y.0000000098Wan D, Krassioukov AV. Life-threatening outcomes associated with autonomic dysreflexia: a clinical review. J Spinal Cord Med. 2014;37(1):2-10. https://doi.org/10.1179/2045772313Y.0000000098Lindan R, Joiner E, Freehafer AA, Hazel C. Incidence and clinical features of autonomic dysreflexia in patients with spinal cord injury. Paraplegia. 1980;18(5):285-92. https://doi.org/10.1038/sc.1980.51Lindan R, Joiner E, Freehafer AA, Hazel C. Incidence and clinical features of autonomic dysreflexia in patients with spinal cord injury. Paraplegia. 1980;18(5):285-92. https://doi.org/10.1038/sc.1980.51Cragg J, Krassioukov A. Autonomic dysreflexia. CMAJ. 2012;184(1):66. https://doi.org/10.1503/cmaj.110859Cragg J, Krassioukov A. Autonomic dysreflexia. CMAJ. 2012;184(1):66. https://doi.org/10.1503/cmaj.110859Hubli M, Gee CM, Krassioukov AV. Refined assessment of blood pressure instability after spinal cord injury. Am J Hypertens. 2015;28(2):173-81. https://doi.org/10.1093/ajh/hpu122Hubli M, Gee CM, Krassioukov AV. Refined assessment of blood pressure instability after spinal cord injury. Am J Hypertens. 2015;28(2):173-81. https://doi.org/10.1093/ajh/hpu122Eldahan KC, Rabchevsky AG. Autonomic dysreflexia after spinal cord injury: Systemic pathophysiology and methods of management. Auton Neurosci. 2018;209:59-70. https://doi.org/10.1016/j.autneu.2017.05.002Eldahan KC, Rabchevsky AG. Autonomic dysreflexia after spinal cord injury: Systemic pathophysiology and methods of management. Auton Neurosci. 2018;209:59-70. https://doi.org/10.1016/j.autneu.2017.05.002Canon S, Shera A, Phan NM, Lapicz L, Scheidweiler T, Batchelor L, Swearingen C. Autonomic dysreflexia during urodynamics in children and adolescents with spinal cord injury or severe neurologic disease. J Pediatr Urol. 2015;11(1):32.e1-4. https://doi.org/10.1016/j.jpurol.2014.08.011Canon S, Shera A, Phan NM, Lapicz L, Scheidweiler T, Batchelor L, Swearingen C. Autonomic dysreflexia during urodynamics in children and adolescents with spinal cord injury or severe neurologic disease. J Pediatr Urol. 2015;11(1):32.e1-4. https://doi.org/10.1016/j.jpurol.2014.08.011Snow JC, Sideropoulos HP, Kripke BJ, Freed MM, Shah NK, Schlesinger RM. Autonomic hyperreflexia during cystoscopy in patients with high spinal cord injuries. Paraplegia. 1978;15(4):327-32. https://doi.org/10.1038/sc.1977.49Snow JC, Sideropoulos HP, Kripke BJ, Freed MM, Shah NK, Schlesinger RM. Autonomic hyperreflexia during cystoscopy in patients with high spinal cord injuries. Paraplegia. 1978;15(4):327-32. https://doi.org/10.1038/sc.1977.49Milligan J, Lee J, McMillan C, Klassen H. Autonomic dysreflexia: recognizing a common serious condition in patients with spinal cord injury. Can Fam Physician. 2012;58(8):831-5. PMCID: PMC3418979Milligan J, Lee J, McMillan C, Klassen H. Autonomic dysreflexia: recognizing a common serious condition in patients with spinal cord injury. Can Fam Physician. 2012;58(8):831-5. PMCID: PMC3418979Brown R, Burton AR, Macefield VG. Autonomic dysreflexia: Somatosympathetic and viscerosympathetic vasoconstrictor responses to innocuous and noxious sensory stimulation below lesion in human spinal cord injury. Auton Neurosci. 2018;209:71-78. https://doi.org/10.1016/j.autneu.2017.07.003Brown R, Burton AR, Macefield VG. Autonomic dysreflexia: Somatosympathetic and viscerosympathetic vasoconstrictor responses to innocuous and noxious sensory stimulation below lesion in human spinal cord injury. Auton Neurosci. 2018;209:71-78. https://doi.org/10.1016/j.autneu.2017.07.003Groen J, Pannek J, Castro Diaz D, Del Popolo G, Gross T, Hamid R, Karsenty G, Kessler TM, Schneider M, 't Hoen L, Blok B. Summary of European Association of Urology (EAU) Guidelines on Neuro-Urology. Eur Urol. 2016;69(2):324-33.https://doi.org/10.1016/j.eururo.2015.07.071Groen J, Pannek J, Castro Diaz D, Del Popolo G, Gross T, Hamid R, Karsenty G, Kessler TM, Schneider M, 't Hoen L, Blok B. Summary of European Association of Urology (EAU) Guidelines on Neuro-Urology. Eur Urol. 2016;69(2):324-33.https://doi.org/10.1016/j.eururo.2015.07.071Abrams P, Cardozo L, Fall M, Griffiths D, Rosier P, Ulmsten U, Van Kerrebroeck P, Victor A, Wein A; Standardisation Sub-Committee of the International Continence Society. The standardisation of terminology in lower urinary tract function: report from the standardisation sub-committee of the International Continence Society. Urology. 2003;61(1):37-49. https://doi.org/10.1016/s0090-4295(02)02243-4Abrams P, Cardozo L, Fall M, Griffiths D, Rosier P, Ulmsten U, Van Kerrebroeck P, Victor A, Wein A; Standardisation Sub-Committee of the International Continence Society. The standardisation of terminology in lower urinary tract function: report from the standardisation sub-committee of the International Continence Society. Urology. 2003;61(1):37-49. https://doi.org/10.1016/s0090-4295(02)02243-4Eltorai I, Kim R, Vulpe M, Kasravi H, Ho W. Fatal cerebral hemorrhage due to autonomic dysreflexia in a tetraplegic patient: case report and review. Paraplegia. 1992;30(5):355-60. https://doi.org/10.1038/sc.1992.82Eltorai I, Kim R, Vulpe M, Kasravi H, Ho W. Fatal cerebral hemorrhage due to autonomic dysreflexia in a tetraplegic patient: case report and review. Paraplegia. 1992;30(5):355-60. https://doi.org/10.1038/sc.1992.82Giannantoni A, Di Stasi SM, Scivoletto G, Mollo A, Silecchia A, Fuoco U, Vespasiani G. Autonomic dysreflexia during urodynamics. Spinal Cord. 1998;36(11):756-60. https://doi.org/10.1038/sj.sc.3100684Giannantoni A, Di Stasi SM, Scivoletto G, Mollo A, Silecchia A, Fuoco U, Vespasiani G. Autonomic dysreflexia during urodynamics. Spinal Cord. 1998;36(11):756-60. https://doi.org/10.1038/sj.sc.3100684Liu N, Fougere R, Zhou MW, Nigro MK, Krassioukov AV. Autonomic dysreflexia severity during urodynamics and cystoscopy in individuals with spinal cord injury. Spinal Cord. 2013;51(11):863-7. https://doi.org/10.1038/sc.2013.113Liu N, Fougere R, Zhou MW, Nigro MK, Krassioukov AV. Autonomic dysreflexia severity during urodynamics and cystoscopy in individuals with spinal cord injury. Spinal Cord. 2013;51(11):863-7. https://doi.org/10.1038/sc.2013.113Faaborg PM, Christensen P, Krassioukov A, Laurberg S, Frandsen E, Krogh K. Autonomic dysreflexia during bowel evacuation procedures and bladder filling in subjects with spinal cord injury. Spinal Cord. 2014;52(6):494-8. https://doi.org/10.1038/sc.2014.45Faaborg PM, Christensen P, Krassioukov A, Laurberg S, Frandsen E, Krogh K. Autonomic dysreflexia during bowel evacuation procedures and bladder filling in subjects with spinal cord injury. Spinal Cord. 2014;52(6):494-8. https://doi.org/10.1038/sc.2014.45Shergill IS, Arya M, Hamid R, Khastgir J, Patel HR, Shah PJ. The importance of autonomic dysreflexia to the urologist. BJU Int. 2004;93(7):923-6. https://doi.org/10.1111/j.1464-410X.2003.04756.xShergill IS, Arya M, Hamid R, Khastgir J, Patel HR, Shah PJ. The importance of autonomic dysreflexia to the urologist. BJU Int. 2004;93(7):923-6. https://doi.org/10.1111/j.1464-410X.2003.04756.xAllen KJ, Leslie SW. Autonomic Dysreflexia. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022. PMID: 29494041 Bookshelf ID: NBK482434Allen KJ, Leslie SW. Autonomic Dysreflexia. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022. PMID: 29494041 Bookshelf ID: NBK482434Linsenmeyer TA, Campagnolo DI, Chou IH. Silent autonomic dysreflexia during voiding in men with spinal cord injuries. J Urol. 1996;155(2):519-22. PMID: 8558650Linsenmeyer TA, Campagnolo DI, Chou IH. Silent autonomic dysreflexia during voiding in men with spinal cord injuries. J Urol. 1996;155(2):519-22. PMID: 8558650

The authors declare that there are no conflicts of interest present.