324
CHAPTER 26
infection of the bladder has been allowed to develop or pre-paraplegic bladder abnor
malities were present.
III. Final Stages
(a) CO-ORDINATED VESICAL REFLEX FUNCTION
Once full reflex automatism has developed, various types of automatic bladder may
emerge. In the ideal form, especially in incomplete transverse lesions, the detrusor will
react with one strong contraction, as occurs in normal individuals, once the critical point
of bladder distension is reached, and the bladder will be almost completely emptied.
This reflex micturition may occur, according to the bladder capacity, every 2-4 hours,
and amounts of 250-350 ccs of urine may be expelled. This is the ideal type of co
ordinated automatic reflex bladder. However, in the majority of complete cord lesions
with otherwise co-ordinated vesical reflex function, several detrusor contractions may
occur in response to bladder distension to ensure complete emptying (Fig. 139).
(b) DISCO-ORDINATED VESICAL REFLEX FUNCTION
The relation between distension of the bladder and the reflex responses of opening and
closing mechanisms is often disturbed at one stage or another. The resulting disturbances
of reflex micturition in both complete and incomplete lesions have to be analysed
DATE an
250
20O
150
IOO
5O
70
PULSE
60
50-
25
TIME
5
(3)
(V) CVSTOGRAMS
5O
75
IOO 125
I5O
VOLUME IN CU CMS
IO
15
2O
25'
3O
35'
FIG. 140.
