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CHAPTER 26
C. AXONAL INNERVATION
Modern studies using electron microscope and microelectrode have furnished details of
the intricate axon innervation of individual muscle cells of the detrusor (Caesar
et al.,
1957). I* was found that one axon innervates a number of smooth muscle cells, and one
muscle cell may be in contact with several axons. Stretch receptors in the bladder have
been described (Iggo, 1955), and it was found that stretch increases excitability by
depolarizing the muscle cell (Ursillo, 1961).
GENERAL DOCUMENTATION
AND CLASSIFICATION
For a comprehensive classification and documentation of vesical disorders sequential
to lesions of any parts of the nervous system and their effects on other organs of the
organism especially the upper urinary tract, the evaluation of a considerable number of
data arising from clinical and experimental investigations is indispensable. In modification
with those outlined recently by Bors (1967), Bradley (1967), Markland
et aL
(1967), the
following investigations have to be considered:
1.
Full neurological examination
to determine onset, site, type, completeness and duration
of the neurological affliction. In addition to defining the deficit of motor, sensory and
autonomous functions, attention should be paid to investigations of the state of reflexes
in the lower limbs and, especially, to the bulbo-cavernosus, anal and cremasteric reflexes
during the stage of spinal shock as well as during the various phases of reflex return.
2.
Clinical evaluation of bladder function.
This includes examination of micturition at will,
on desire, preparaplegic habits of micturition, flow rate, ability to stop flow, participation
of the abdominal muscles in the act of micturition, onset of retention, urgency, and
frequency as well as types of incontinence. In lesions of central stations of the nervous
system, in particular complete lesions of the spinal cord above the level of the thoraco-
lumbar junction, the essential points to be considered are: duration of spinal shock,
onset or permanent absence of reflex micturition, date of onset and cessation of cathe-
terization, degree of residual urine, infection, symptoms of bladder distension and auto
matic detrusor activity resulting in local sensation with or without associated cardio
vascular and other autonomic responses, facilitation of voiding by various types of
trigger mechanisms, last but by no means least the patient's ability to adjust himself to
his bladder dysfunction.
3.
Diagnostic and experimental tests of bladder and renal function
a Residual urine tests (in lying and vertical positions).
b Detailed laboratory urine analysis including specific gravity test, cells, protein
