Almost any precipitant below the neurologic lesion can trigger autonomic dysreflexia. Important to the urologist, a genitourinary cause is responsible in 81 %-87% of cases (Shergill et al. 2004). The commonest reason for autonomic dysreflexia is bladder distension, ac counting for 75%-85% of cases (Blackmer 2003). Bladder distension can be a consequence of a kinked or obstructed catheter as well as an insufficient intermittent catheterization frequency. Other urinary triggers are infection, instrumentation, stones, and urethral distension.

As almost 90 % of cases have a genitourinary cause, it is particularly important for the urologist to prevent autonomic dysreflexia. When treating patients with SCI, the urologist should be aware of the possibility of autonomic dysreflexia. When performing instrumentation of the lower urinary tract, for example changing a catheter, local anesthetic jelly and an aseptic technique (to avoid urinary tract infection as a precipitant of autonomic dysreflexia) should be used. If the instrumentation takes more than a few minutes (cystoscopy, urodynamic investigation) sufficient blood pressure monitoring should also be provided. It should also be noted that even sexual intercourse can effect autonomic dysreflexia. Therefore the andrologist should keep in mind this risk when applying vibroejaculation to a SCI patient.

The second most common precipitant for autonom-ic dysreflexia is bowel distension (13 % -19 % of cases).

Table 9.1 displays precipitants for autonomic dysref-lexia.

Table 9.1. Precipitants for autonomic dysreflexia


Bladder distension (kinked/obstructed catheter)


Urethral distension

Instrumentation (indwelling catheter, cystos

copy, urodynamics)


Ejaculation (vibro- or electroejaculation)

Sexual intercourse


Bowel distension (fecal impaction)



Infection or inflammation (colitis, peritonitis)

Gastric ulcer



Anal fissure


Pressure sore


Ingrown toenail

Burns (sunburns, burns from hot water)

Tight clothing or pressure to skin


Heterotopic ossification


Joint dislocation


Labor and delivery



Testicular torsion


Deep vein thrombosis


Pulmonary embolism

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