Systematic Review of AD
As knowledge is growing in the field of AD management in the SCI population, it is important to regularly review the literature and ensure that the information used both in research and practice is current and evidence based. This section will provide an overview of the current systematic reviews available in the areas related to AD management in the SCI population.
Discussion
We found four systematic reviews examining the effectiveness of AD management interventions.
The systematic review by Liu et al. (2015) explored the incidence of AD during diagnostic procedures of the bladder in people with SCI and found a high incidence rate in urodynamics and that the majority of patients without anesthesia developed AD during cystoscopy, transurethral litholapaxy, and extracorporeal shock wave lithotripsy (EWSL). Nifedipine was shown to be the most effective medication during urodynamics, cystoscopy, and ESWL for relief of acute episodes and prevention of AD.
Nifedipine was the most widely studied and significant treatment of AD whether in acute or prophylactic conditions. Courtois et al. (2012) reviewed the literature on the acute or prophylactic treatment of AD in the context of sexual activities; they found multiple studies with strong evidence that nifedipine was effective for preventing AD during electroejaculation and vibrostimulation.
Gray et al. (2022) found six studies examining the effectiveness of lidocaine on AD, with the majority supporting its use with a beneficial effect on AD during bowel procedures, urological care, or functional electrical stimulation. Similarly, Krassioukov et al. (2009) found strong evidence that intravesical resiniferatoxin and intersphincteric anal block with lidocaine were effective in the prevention of AD episodes. The same authors also found evidence that nifedipine is useful in the prevention of dangerous blood pressure elevation during diagnostic or therapeutic procedures. However, Krassioukov et al. (2009) concluded that topical lidocaine is not beneficial for the management of AD in the SCI population. Finally, these authors found limited evidence supporting the use of botulinum toxin injections into the detrusor muscle and no support for the use of anticholinergics for AD management.
Although higher quality research assessing the management of AD in the SCI population is needed, Liu et al. (2015)concluded that careful evaluation, increased awareness, and early recognition of possible triggers remains the most effective approach in AD prevention and management for individuals with SCI.
