Autonomic Dysreflexia in Urodynamics Studies: Recognition and Management

Abstract Purpose of review Autonomic dysreflexia (AD) can be a serious complication encountered during urodynamic studies (UDS) in patients with suprasacral spinal cord injury. This review serves to summarize current and emerging evidence regarding the identification, prevention, and management of AD in the UDS setting with the goal of providing clinicians with practical strategies to safely integrate UDS into the clinic while minimizing patient risk. Recent findings Findings over the past decade highlighted in our review include an improved understanding of AD pathophysiology and identification of at-risk patients. Updated clinical guidance continues to recommend prompt cessation of bladder stimulation, bladder drainage, and topical nitroglycerin as first-line therapy for acute episodes. Emerging technologies, including wireless catheter-free urodynamic systems, remain investigational in spinal cord injury populations. Likewise, evidence supporting prophylactic interventions - including intravesical lidocaine, nifedipine, and α-adrenergic blockers - remains limited, with insufficient data to support routine use during diagnostic UDS. Summary Safe performance of UDS in patients at risk for AD requires careful pre-procedural assessment, continuous cardiovascular monitoring, early recognition of hemodynamic changes, and standardized treatment protocols. Current evidence favors individualized risk assessment and rapid intervention over routine pharmacologic prophylaxis. Future research should focus on prospective trials evaluating preventive therapies, validating novel urodynamic technologies in spinal cord injury populations, and establishing standardized protocols that optimize diagnostic accuracy while reducing the incidence and severity of procedure-related autonomic dysreflexia.