Pressor Response During Cystomanometry in Spinal Injury Patients Complicated with Detrusor-Sphincter Dyssynergia

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Abstract
The documentation of high blood pressure response with detrusor-sphincter dyssynergia in spinal cord injury patients and its amelioration after extended sphincterotomy was studied. During cytomanometric evaluation of the bladder the monitored blood pressure response in 53 spinal injury patients, 27 non-dyssynergic spinal injury patients and 18 non-spinal injury patients was compared. A high correlation was observed among the magnitudes of blood pressure increase, levels of injury and the severity of detrusor-sphincter dyssynergia in spinal injury patients. During cystomanometry blood pressure increases of > 20 mm. Hg systolic and 10 mm Hg diastolic in normotensive paraplegics (below T[thoracic]5) and also in non-spinal injury patients were significant to suspect detrusor-sphincter dyssynergia. In normotensive tetraplegic patients blood pressure increases of > 40 mm. Hg systolic and 20 mm. Hg diastolic were significant to suspect detrusor-sphincter dyssynergia. The mechanism of blood pressure increase is elucidated. The management of this high blood pressure response in patients with detrusor-sphincter dyssynergia by drug therapy and extended sphincterotomy is discussed. The use of CO2 for cystomanometry seems preferable in patients with spinal lesions above T5 since expedient deflation of the bladder can prevent an inordinate blood pressure increase.