F • CLINICAL ASPECTS OF SPINAL CORD INJURIES
321
electrolytes, culture (type of infection) and renal function tests (blood urea, creatinine
clearance, Bo-microglobuline osmolality).
c Straight X-ray of urinary tract (demonstration of stones and/or chronic constipation),
d Cystometry combined, if indicated, with sphincterometry (determination of tone
and changes of bladder function).
e Intravenous pyelogram (renal and ureteric changes, early pyelitis).
f Cysto-urethrogram by fractionized slow filling of bladder and delayed X-ray. (Demon
stration of shape and capacity of bladder, diverticulosis of urethra and bladder, types of
reflux, ureter kinking and blockage.)
g Voiding cysto-urethrogram with fluoroscopy combined, if indicated, with cineradio-
graphy.
h Cystoscopy, if indicated, for retrograde pyelography or to determine hypertrophy of
bladder neck, blockage at external urethral sphincter, internal bladder orifice, or ureteric
level and other structural pathology.
i Diagnostic anaesthesias (mucosal, pudendal, epidural, subarachnoid block, all of
which are rarely indicated).
j
Radio-isotope test for renal function, if indicated,
k Electro-myography and electrical stimulation test, if indicated.
1
Dip slides urine test (Dennis Guttmann and S. R. Naylor, 1967) for out-patients to
minimize in-patient check ups of paraplegics in employment.
DYSFUNCTIONS OF THE BLADDER IN SPINAL
CORD AND CAUDA EQUINA LESIONS
(CLASSIFICATION AND TREATMENT)
Amongst the afflictions of the various stations of the nervous system, those of the spinal
cord and cauda equina, in particular, have been the subject of intensive investigation
and research after the Second World War, with regard to vesical disorders, and they can
be more readily classified than can afflictions of other parts of the nervous system, such
as cortical and subcortical lesions. How far future documentation and patient planning
with the aid of a computer will be possible, remains to be seen (Carter & Jackson, 1971).
I. Stage of spinal shock (vesical hypo- or areflexia) retention and
overflow incontinence (ischuria paradoxa)
In the initial stage of an acute transverse spinal cord lesion, regardless of level and
whether the lesion remains complete or in due course becomes incomplete, all connec
tions between the spinal vesical reflex centre and its facilitatory and inhibitory cerebral
centres are interrupted. In this stage, termed by Marshall Hall (1841) 'spinal shock5 ,
there is a depression and imbalance of the reflex activity of the isolated cord for all
efferent and afferent stimuli. As a result, any volitional or reflex function of the bladder is
abolished. There is no desire to urinate, and the bladder no longer responds to an appro
priate degree of distension by efficient reflex contraction. Commensurate with the flaccid
