Development of autonomic dysreflexia (AD) is described in patients with high transversal spinal lesion – above the level C6. While applying methods of assisted reproduction, AD is described at performing artificial ejaculation – vibrostimulation or electroejaculation. We have not found any references to occurence of AD in connection to TESE in the Medline database. Material and methods: A 32-year-old patient, 16 years after injury with a spinal lesion at the level C6, was admitted to have TESE performed under spinal anesthesia. The procedure was without complications. A permanent urinary catheter was introduced, which the patient had no problem torelating in the past. Once the effects of anesthesia subsided, autonomic dysreflexia developed – anxiety and restlessness, profuse sweating on the upper half of the body with gradual increase in blood pressure up to values of 220/130, massive macroscopic hematuria appears. Upon introduction of complex pharmacotherapy regimen, there is only partial stabilization of the condition. Final normalization of the condition occurs 60 hours after extraction of the permanent urinary catheter, which had been left there before due to danger of tamponade of the urinary bladder. Further course was without complications. Results: Overall high reflex activity in a patient with a high spinal lesion, along with a long-term poor bladder emptying and a surgical procedure in an exceptionally strong reflexively active area, lead to the development of AD, which was managed only after removing all offending stimuli from the pelvic area and after consistent complex pharmacotherapy, i.e. after consistent administration of analgesics, anxiolytics and a combination of antihypertensitives. Conclusions: Performing TESE on patients with high spinal lesion can be accompanied by AD not only directly during the surgical procedure, but also in postoperative period.

Traumatological Hospital of Brno Trauma centre Department of Traumatology at the Medical Faculty Masaryk University Brno

2. český a mezinárodní andrologický kongres, Štiřín, 3.-5.5.2007