Autonomic dysreflexia during sperm retrieval in spinal cord injury: influence of lesion level and sildenafil citrate

Autonomic dysreflexia (AD) can occur during penile vibratory stimulation in men with spinal cord injury, but this is variable, and the association with lesion level is unclear. The purpose of this study was to characterize the cardiovascular responses to penile vibratory stimulation in men with spinal cord injury. We hypothesized that those with cervical injuries would demonstrate a greater degree of AD compared with men with thoracic injuries. We also questioned whether the rise in blood pressure could be attenuated by sildenafil citrate. Participants were classified as having cervical ( n = 8) or thoracic ( n = 5) injuries. While in a supine position, subjects were instrumented with an ECG, and arterial blood pressure was determined beat by beat. Subjects reported to the laboratory twice and received an oral dose of sildenafil citrate (25–100 mg) or no medication. Penile vibratory stimulation was performed using a handheld vibrator to the point of ejaculation. At ejaculation during the nonmedicated trials, the cervical group had a significant decrease in heart rate (−5–10 beats/min) and increase in mean arterial blood pressure (+70–90 mmHg) relative to resting conditions, whereas the thoracic group had significant increases in both heart rate (+8–15 beats/min) and mean arterial pressure (+25–30 mmHg). Sildenafil citrate had no effect on the change in heart rate or mean arterial pressure in either group. In summary, men with cervical injuries had more pronounced AD during penile vibratory stimulation than men with thoracic injuries. Administration of sildenafil citrate had no effect on heart rate or blood pressure during penile vibratory stimulation in men with spinal cord injury.

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Cutaneous vasoconstriction as a measure of incipient autonomic dysreflexia during penile vibratory stimulation in spinal cord injury

Spinal Cord ◽

10.1038/sc.2008.158 ◽

2008 ◽

Vol 47 (7) ◽

pp. 538-544 ◽

Cited By ~ 10

Author(s):

R Brown ◽

G Stolzenhein ◽

S Engel ◽

V G Macefield

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Autonomic Dysreflexia ◽

Vibratory Stimulation ◽

Cord Injury ◽

Penile Vibratory Stimulation ◽

Cutaneous Vasoconstriction

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Prevalence of Autonomic Dysreflexia in Patients with Spinal Cord Injury above T6

BioMed Research International ◽

10.1155/2017/2027594 ◽

2017 ◽

Vol 2017 ◽

pp. 1-6 ◽

Cited By ~ 2

Author(s):

Eun Sun Lee ◽

Min Cheol Joo

Keyword(s):

Blood Pressure ◽

Spinal Cord ◽

Heart Rate ◽

Spinal Cord Injury ◽

Ambulatory Blood Pressure ◽

Blood Pressure Monitoring ◽

Autonomic Dysreflexia ◽

Therapeutic Interventions ◽

Pressure Monitoring ◽

Cord Injury

Objective. To investigate the prevalence of autonomic dysreflexia (AD) using ambulatory blood pressure monitoring (ABPM) and the autonomic dysfunction following spinal cord injury (ADFSCI) questionnaire in patients with spinal cord injury (SCI) above T6.Methods. Twenty-eight patients diagnosed with SCI above T6 were enrolled. ABPM and ADFSCI were utilized to assess AD. Using ABPM, systolic blood pressure (SBP), diastolic blood pressure, and heart rate (HR) were measured at 30-minute intervals. AD was defined as SBP 20 mmHg higher than basal SBP, and the number of AD events was counted. The ADFSCI questionnaire evaluates the severity and frequency of the AD symptoms.Results. According to the ABPM, AD occurred in 26 patients and AD events occurred5.8±4.7times. Average daytime and nighttime SBP were119.9±18.8 mmHg and123.8±21.2 mmHg, respectively, and the nighttime mean SBP appeared to be 4 mmHg higher than daytime mean SBP. These findings suggest the loss of nocturnal BP dipping in SCI patients. ADFSCI results revealed that 16 of the patients evaluated were symptomatic while 12 were asymptomatic.Conclusion. AD following SCI above T6 was highly prevalent and several patients seemed asymptomatic. These results suggest the necessity of proper diagnostic and therapeutic interventions for managing AD.

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Cardiovascular responses to vaginocervical stimulation in the spinal cord-transected rat

AJP Regulatory Integrative and Comparative Physiology ◽

10.1152/ajpregu.1997.273.4.r1361 ◽

1997 ◽

Vol 273 (4) ◽

pp. R1361-R1366 ◽

Cited By ~ 2

Author(s):

Giorgio R. Sansone ◽

Ralph Bianca ◽

Rafael Cueva-Rolón ◽

Lisbeth E. Gómez ◽

Barry R. Komisaruk

Keyword(s):

Blood Pressure ◽

Spinal Cord ◽

Heart Rate ◽

Spinal Cord Injury ◽

Cardiovascular Responses ◽

Spinal Cord Transection ◽

Autonomic Dysreflexia ◽

Control Group ◽

Cord Injury ◽

Sh Group

The present study ascertained whether increases in heart rate (HR) and systolic blood pressure (SBP) produced by vaginocervical stimulation (VS; 500 g force) persist in the unanesthetized rat after chronic spinal cord transection at selected levels. Three groups were used: spinal cord transection at T7 ( n = 10) or L5 ( n = 10) or a sham-operated control group (Sh, n = 10). In the Sh group, VS increased significantly both HR, by 95 ± 14.3 beats/min (bpm) (22 ± 3.7% above baseline), and BP, by 37 ± 5.7 mmHg (37 ± 7.7% above baseline), confirming earlier findings. In the T7 group, VS significantly decreased HR by 107 ± 21.4 bpm (27 ± 4.1% below baseline) and increased BP by 41.3 ± 12.9 mmHg (32 ± 8.3% above baseline). In response to VS, HR increased in every rat in the Sh group and decreased in every rat in the T7 group. In the L5 group, VS failed to significantly affect HR or BP. In the present study, specific levels of spinal cord transection produced differential HR and BP responses to VS in the rat. A model is presented addressing the component responses of autonomic dysreflexia that can occur, contingent on the level of spinal cord injury, in women during parturition or sexual intercourse.

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Autonomic Dysreflexia Among Men With Spinal Cord Injury Undergoing Penile Vibratory Stimulation

Journal of Andrology ◽

10.2164/jandrol.107.003707 ◽

2007 ◽

Vol 28 (6) ◽

pp. 800-800 ◽

Cited By ~ 1

Author(s):

T. J. Pshak ◽

R. B. Meacham

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Autonomic Dysreflexia ◽

Vibratory Stimulation ◽

Cord Injury ◽

Penile Vibratory Stimulation

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Diurnal Blood Pressure Variation in Quadriplegic Chronic Spinal Cord Injury Patients

Clinical Science ◽

10.1042/cs0800271 ◽

1991 ◽

Vol 80 (3) ◽

pp. 271-276 ◽

Cited By ~ 30

Author(s):

Henry Krum ◽

William J. Louis ◽

Douglas J. Brown ◽

Graham P. Jackman ◽

Laurence G. Howes

Keyword(s):

Blood Pressure ◽

Spinal Cord ◽

Heart Rate ◽

Spinal Cord Injury ◽

Ambulatory Monitoring ◽

Pressure Variation ◽

Night Time ◽

Cord Injury ◽

Blood Pressure Variation ◽

Neurologically Intact

1. Measurement of blood pressure and heart rate over a 24 h period was peformed in 10 quadriplegic spinal cord injury patients and 10 immobilized, neurologically intact orthopaedic subjects by using the Spacelabs 90207 automated ambulatory monitoring system. 2. Systolic and diastolic blood pressure fell significantly at night in orthopaedic subjects but not in quadriplegic patients, and night-time blood pressures were similar in both groups. 3. Cumulative summation of differences from a reference value (cusum analysis) confirmed a markedly diminished diurnal blood pressure variation in the quadriplegic patients. 4. These findings could not be accounted for on the basis of blood pressure variations during chronic postural change. 5. Heart rate fell significantly at night in both groups. 6. The findings suggest that the increase in blood pressure during waking hours in neurologically intact subjects is a consequence of a diurnal variation in sympathetic activity (absent in quadriplegic patients with sympathetic decentralization) which is independent of changes in physical activity.

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Increased vascular resistance in paralyzed legs after spinal cord injury is reversible by training

Journal of Applied Physiology ◽

10.1152/japplphysiol.00897.2001 ◽

2002 ◽

Vol 93 (6) ◽

pp. 1966-1972 ◽

Cited By ~ 64

Author(s):

Maria T. E. Hopman ◽

Jan T. Groothuis ◽

Marcel Flendrie ◽

Karin H. L. Gerrits ◽

Sibrand Houtman

Keyword(s):

Blood Pressure ◽

Spinal Cord ◽

Spinal Cord Injury ◽

Blood Flow ◽

Mean Arterial Pressure ◽

Arterial Pressure ◽

Vascular Resistance ◽

Arterial Blood Flow ◽

Arterial Blood ◽

Cord Injury

The purpose of the present study was to determine the effect of a spinal cord injury (SCI) on resting vascular resistance in paralyzed legs in humans. To accomplish this goal, we measured blood pressure and resting flow above and below the lesion (by using venous occlusion plethysmography) in 11 patients with SCI and in 10 healthy controls (C). Relative vascular resistance was calculated as mean arterial pressure in millimeters of mercury divided by the arterial blood flow in milliliters per minute per 100 milliliters of tissue. Arterial blood flow in the sympathetically deprived and paralyzed legs of SCI was significantly lower than leg blood flow in C. Because mean arterial pressure showed no differences between both groups, leg vascular resistance in SCI was significantly higher than in C. Within the SCI group, arterial blood flow was significantly higher and vascular resistance significantly lower in the arms than in the legs. To distinguish between the effect of loss of central neural control vs. deconditioning, a group of nine SCI patients was trained for 6 wk and showed a 30% increase in leg blood flow with unchanged blood pressure levels, indicating a marked reduction in vascular resistance. In conclusion, vascular resistance is increased in the paralyzed legs of individuals with SCI and is reversible by training.

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