Key Points

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  • The identification and removal of the possible trigger and subsequent decrease of afferent stimulation to the spinal cord is the most effective prevention strategy in clinical practice.
  • Botulinum toxin injections into the detrusor muscle or external urethral sphincter seem to be a safe and valuable therapeutic option in SCI patients who perform clean intermittent self-catheterization and have incontinence resistant to anticholinergic medications. Its use in the prevention of AD is less well defined.
  • Capsaicin and its analogue, resiniferatoxin, are effective in the management of AD in patients with SCI.
  • Anticholinergics do not appear to be sufficient for the management of AD in SCI.
  • Sacral deafferentation may reduce AD during urodynamic investigations.
  • Urinary bladder surgical augmentations may diminish or resolve episodes of AD.
  • Lidocaine anal block can limit the AD response in susceptible patients undergoing anorectal procedures.
  • Topical lidocaine may prevent AD during digital bowel stimulation but does not prevent AD during anorectal procedures.
  • Adequate anesthesia (spinal or epidural if possible) is needed with vaginal delivery, Caesarean delivery or instrumental delivery.
  • Anesthesiologists and surgeons dealing with SCI patients must know how to recognize the AD syndrome, how to prevent its occurrence and how to manage it.
  • Epidural anesthesia is preferred and effective for most women with AD during labour and delivery.
  • Anesthesia should be used during surgical procedures in individuals with SCI despite apparent lack of sensation.
  • Topical anesthetic is not effective for the prevention of AD during FES.
  • Nifedipine may be useful to prevent or control AD in SCI individuals; however, serious adverse effects from its use may occur similar to those reported in other populations.
  • Nitrates are commonly used in the control of AD in SCI; however, no studies have been done to show their effectiveness or safety in SCI.
  • Preliminary evidence suggests that captopril is effective for the management of AD in SCI.
  • There is limited evidence for the use of Terazosin as an agent for control of AD in SCI individuals.
  • Prazosin can prophylactically reduce severity and duration of AD episodes in SCI.
  • It is not known whether Phenoxybenzamine is effective for the management of AD in SCI.
  • Prostaglandin E2 is effective for reducing BP responses during eletroejaculation.
  • Sildenafil has no effect on AD responses in men with SCI during ejaculation.