Editing Neurogenic LUT Dysfunction (section)

==== Autonomic hyperreflexia (dysreflexia) ====
* '''See [[CUA: Neurogenic Lower Urinary Tract Dysfunction (2019)|2019 CUA NLUTD Guideline Notes]]'''
*'''Potentially fatal emergency unique to the SCI patient'''
* Onset after injury is variable—usually soon after spinal shock, but it may occur up to years after injury, and distal spinal cord viability is a prerequisite.
* '''Represents an acute massive disordered autonomic (primarily sympathetic) response in patients with SCI above the cord level of T6-T8 (the sympathetic outflow) to specific stimuli below the level of the lesion'''
* '''Symptoms (5):'''
*# '''Pounding headache'''
*# '''Hypertension'''
*# '''Flushing and sweating above the level of the lesion'''
*# '''Bradycardia'''
*#* Tachycardia or arrhythmia may be present
*# '''Hypertension'''
*#* May vary in severity from causing a mild headache before voiding to life-threatening cerebral hemorrhage or seizure
* The pathophysiology is that of nociceptive stimulation via afferent impulses that ascend through the cord and elicit reflex motor outflow, causing arteriolar, pilomotor, and pelvic visceral spasm and sweating. Normally, the reflexes would be inhibited by secondary output from the medulla, but because of the SCI this does not occur below the lesion level.
* '''The stimuli for this exaggerated response commonly arise from the bladder or rectum and typically involve distention.''' '''Precipitation may be the result of simple LUT instrumentation, tube change, catheter obstruction, or clot retention, and in such cases the symptoms resolve quickly if the stimulus is withdrawn.'''
* '''Ideally, any endoscopic procedure in susceptible patients should be done using spinal anesthesia or carefully monitored general anesthesia'''.
* '''Acutely, the hemodynamic effects of this syndrome may be managed with β- and/or α-adrenergic blocking agents.'''
** '''Sublingual nifedipine is capable of alleviating this syndrome when given during cystoscopy (10 to 20 mg) and of preventing it when given orally 30 minutes before cystoscopy (10 mg)'''
** No consensus on the acute pharmacologic management of autonomic dysreflexia when necessary;