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CHAPTER 26
after injury, as the result of a large residual urine. A bladder neck resection was carried
out (Dr Walsh) to relieve the back pressure. This operation, while eliminating the residual
urine, proved otherwise unsuccessful, as it resulted in ascending infection of the urinary
tract and further increase of hydronephrosis.
In 6 other patients with hydronephrosis, the hydronephrosis developed as a result of
infection and high residual urine. They all also had ureteric reflux. Four were treated
with antibiotics and indwelling catheter and of these two improved and two remained
unchanged. Three of the patients with hydronephrosis were found to have ureteric
strictures one, three and five years after injury. They were treated by ureterolysis with
considerable improvement, but a certain degree of hydronephrosis persisted in all three.
VESICAL URETERIC REFLUX
Twenty-one patients (4-4 per cent) including 2 females had ureteric reflux, 15 unilateral
and 6 bilateral. Their neurological lesions are also shown in Tables 18 and 19. All these
patients had been infected before cystogram, at which reflux was demonstrated. Six
patients with reflux leading to hydronephrosis have been described in the preceding
section, of the remaining 15 patients 4 were treated successfully with antibiotics and had
normal cystogram and I.V.P. later. One patient was treated with temporary Foley
catheter while 10 had to have a permanent indwelling catheter; of these 5 subsequently
had cystograms without reflux but the indwelling catheter was retained because of
chronic infection which did not subside with antibiotic treatment.
DIVERTICULA OF BLADDER
The majority of patients did not have cystograms but of those who did 12 (2 sterile)
showed the appearance of diverticulosis or trabeculation and a further 80 (6 sterile)
showed only slightly irregular bladder outlines.
RENAL STONES
Eight patients (1-7 per cent) including 2 females developed renal stones, three bilateral,
five unilateral. The time lapse between injury and diagnosis of the stones is shown in
Table 19. All these patients had had severe urinary infection before these stones were
diagnosed, and in all 8 patients, stones were removed surgically (Dr Walsh). In 3 patients
there has been no recurrence, in 5 the stones recurred and further removal was attempted
in 3. In 2 of these the stones have recurred. Two of these patients died.
BLADDER STONES
Three patients (0-6 per cent) 2 male, i female, developed bladder stones, 2 while being
treated with Foley catheters. The stones were removed by cystoscopy in 2 cases and in i
by open surgery. This outstandingly low instance of calculosis in bladder and kidneys
compares most favourably with 22-5 per cent of calculosis amongst 351 patients of
