F • CLINICAL ASPECTS OF SPINAL CORD INJURIES
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has passed. On the other hand, paralysis of striated muscles of the closing mechanism
of micturition, the remaining or re-established detrusor function may cause dribbling
incontinence.
D. VESICAL DYSFUNCTION FOLLOWING
POSTERIOR ROOT DEGENERATION
Special mention may be made of the dysfunction of the bladder following destruction
or degeneration of all sacral posterior roots. This is seldom found in traumatic lesions in
its classical form but is often associated with tabes dorsalis and diabetic neuropathy. The
loss of sensibility results in loss of desire to urinate and consequently the bladder becomes
increasingly distended and atonic. Voiding occurs in the form of continuous dribbling
incontinence. The cystometric curve is flat with a shift to the right.
MANAGEMENT AND RECONDITIONING OF
BLADDER DYSFUNCTION
GENERAL CONSIDERATIONS
This represents a complex process of re-adjustment of the bladder function to the
neurological deficit. In this process, urinary retention as well as urinary incontinence
has to be considered. The sooner and the more in detail the patient is made aware of his
individual type of bladder dysfunction, the sooner he may become conscious of his own
responsibility and active co-operation in overcoming his vesical disability, especially in
later stages when he has regained his upright position and is up and about in his wheel-
chair or when his walking capability is restored.
The aims of the management in any stage of bladder paralysis are as follows:
1
Prevention of infection.
2 Prevention of overdistension of the bladder.
3
Prevention of local damage to urethra and bladder by manual expression, instru
mentation, irrigations with irritant chemical solutions and artificial drainage.
4 Maintenance or restoration of a satisfactory bladder capacity.
5
To make the patient catheter-free as soon as possible by restoring in incomplete cord
lesions efficient volitional or, in complete lesions, reflex micturition per urethram with
no or the least possible degree of residual urine or incontinence. In conus-cauda equina
lesions, efficient micturition should be accomplished by training and development of
strong power of the abdominal muscles.
These aims reveal at once the multiple tasks and profound responsibility which
confronts every physician or surgeon who is dealing with spinal paraplegic and tetraplegic
patients both in acute and later stages of bladder paralysis. Today, these unfortunate
people have the right to expect the best and not the second best treatment—i.e. the
employment of those methods of management which from all experience have proved
the most efficient to accomplish the desired aims, in particular the prevention of infection.
