Research Paper Clinical Autonomic Research 7, 299-304 (1997) Simultaneous arterial and urinary bladder pressure measure- ments were recorded during bladder filling in 21 patients with urinary bladder symptoms; seven patients had autonomic failure due to multiple system atrophy (MSA), seven had spinal cord disease of different aetiology with detrusor hyperreflexia (DH) and seven had no neurological abnormalities. A significant increase in average systolic blood pressure (BP) was recorded on bladder filling in the neurologically intact patients (from 110 to 137 mmHg) and in the patients with spinal cord disease and DH (from 109 to 129 mmHg). In those with MSA, the BP rose in four and fell in three patients. The vesicopressor response during cold receptor-mediated DH was not significantly higher when compared with room-temperature saline and when com- pared with the BP response during bladder filling in the neuro- logically intact patients. Finally, intravesical lignocaine retained in the bladder for 15 min did not influence the BP response to cold receptor stimulation in patients with spinal cord disease and DH. These findings and their pathophysiological and clini- cal implications are discussed. Keywords: cystometry; iced-saline test; detrusor hyperreflexia; blood pressure; urinary bladder pressure; intravesical lignocaine Simultaneous arterial and urinary bladder pressure recordings in multiple system atrophy and in spinal disorders with detrusor hyperreflexia T. Petersen MD1, C.J. Mathias DPhil DSc FRCP 2'3, M. Alarn BSc Sci~a, V. Chandiramani MD1 and C.J. Fowler MB BS MSc FRCP 1 1Uro-Neurology, 2Autonomic Unit, University Department of Clinical Neurology, National Hospital for Neurology and Neurosurgery/Institute of Neurology, Queen Square, University College London, and 3Neurovascular Medicine Unit, St Mary's Hospital, Imperial College School of Medicine, University of London, UK Correspondence and reprint requests: T. Petersen, Neurological Department, Aarhus University Hospital, 8000 Aarhus C, Denmark. Tel: (+45) 8949 3333; fax: (+45) 8949 3300 Received 13 March 1997" acceptedin revised form 12 August 1997 Introduction A variety of arterial blood pressure (BP) responses fol- lowing urinary bladder activation has been described in man. A fall in BP may occur during bladder empty- ing after long-term urinary retention, 1 and may cause micturition syncope. A marked increase in BP after urinary bladder distension has been reported in healthy subjects when measured at rest, and at maxi- mal desire to void. 2 In patients with high spinal cord lesions who have detrusor hyperreflexia (DH), paroxysmal hypertension on urinary bladder contraction may occur as part of the syndrome of 'autonomic dysreflexia' (AD). 3'4 This marked response may be related to reorganization of micturition reflexes, as DH occurs when there has been damage to the central controlling pathways of the bladder, with unmasking or development of new reflexes at a spinal cord level. Cystometric investiga- tions in man indicate that these pathways are activated by cold stimulation of bladder afferents, 5 probably mediated through cold receptors subserved by C- fibres6 and instillation of iced saline into the bladder in these patients with spinal cord disease elicits DH in almost all of them. Therefore, a possible mechanism for the phenomenon of AD could be enhanced sensi- tivity of the cold-induced vesicopressor response in spinal cord patients with DH. In that case one would expect this BP response to be higher when compared with the BP response to maximal bladder filling in neurologically intact patients, and in neurological patients without AD. Autonomic impairment of the cardiovascular system occurs in many neurological patients, a major example being multiple system atrophy (MSA).7 The vesicopres- sor response in these patients has not been investigated or discussed before. In these patients the lesions are thought to be predominantly within the brain and the spinal cord, with sparing of the paravertebral ganglia;8~9 the possibility of spinal reflexes causing cardiovascular autonomic effects, therefore, remains. The purpose of this study was to use a new non- invasive technique to measure beat-by-beat arterial BP 1~ simultaneously with urinary bladder activity recorded during cystometry. This was performed in neurologi- cally 'normal' subjects, in patients with MSA and in patients with DH due to spinal cord disease. Urinary bladder stimulation was performed with two different stimuli: distension and cold. Finally the local anaes- thetic, lignocaine, was used to block one or other of the stimuli in subjects with DH due to spinal cord disease. Subjects and methods All the patients in this study underwent urodynamic testing because of urinary symptoms and had been investigated to confirm or exclude neurological dis- ease. The major urinary symptoms were frequency, with or without incontinence. At final diagnosis, in seven patients a diagnosis of MSA was made, in seven 0959-9851 9 1997 Rapid Science Publishers 299