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. The aim of this section is to provide an overview of the current systematic reviews available in this area related to AD management in the SCI population.
We found two systematic reviews looking at the effectiveness of AD management interventions.
Courtois et al. (2012) reported that 37 papers on the specific treatment of AD showed that nifedipine, prazosin, captopril and clonidine are candidates in the context of sexual activity. Krassioukov et al. (2009) found strong evidence that intravesical resiniferatoxin and intersphincteric anal block with lidocaine were effective inthe 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. Krassioukov et al. (2009) also found that topical lidocaine is not beneficial for the management of AD in SCI population. Finally, these authors found only limited evidence supporting the use of botulinum toxin injections into the detrusor muscle and no support for the use of anticholinergicsfor AD management. . Liu et al. (2015) explored the latrogenic urological triggers of AD. AD has a high incidence rate in urodynamics and the majority of patients without anesthesia developed AD during cystoscopy, transurethral litholapaxy, and EWSL. Nifedipine was shown to be the most effective medication during urodynamics, cystoscopy and ESWL for relief of acute AD and for prevention of AD. Although the authors found that higher quality research assessing the management of AD in the SCI population is needed, they concluded that careful evaluation of individuals with SCI and increased awareness and early recognition of possible triggers that could result in AD remains the most effective approach in AD management.