376
CHAPTER 26
dizziness, dryness etc.) than Methanteline Bromide (Banthine) which is used in the
U.S.A. Etamon (Tetrethylammonium) which has an anticholinergic effect was found to
eliminate uninhibited detrusor contractions (Nesbit
el
a/., 1947; Jonsson & Zederfeldt,
1957). Bors & Comarr (1970) found a potentiating effect of Banthine plus Atropin in
reducing detrusor hyperactivity in order to prevent structural contracture. However,
in cases with intractable spasticity, resulting in bladder contracture, transformation of the
uninhibited bladder into an autonomous one by selective anterior rhizotomy or by intra-
thecal alcohol or phenol injections will be necessary if the conservative treatment fails
to improve that condition which can make the patient's life most miserable by adding to
the incontinence hyperreflexia of autonomic mechanisms. Fig. 164 shows the excellent
result of an intrathecal alcohol block in a girl of 24 with a complete thoracic cord lesion
and a disco-ordinated spastic bladder with almost continuous reflex-incontinence which
made her life utterly miserable and prevented her from returning to a useful life. Since
alcohol block she is continent, expressing her bladder at regular intervals, and is for
many years employed as an art teacher. In very selected cases of women who have
developed a dilatation of the urethra by the use of ever-increasing sizes of indwelling
catheters and are continuously incontinent, urinary diversion by ileal conduit can be
justified.
(d) Precipitous.
Precipitous micturition is a form of incontinence which is found in
both traumatic and non-traumatic incomplete lesions of the spinal cord as well as in other
afflictions of the central nervous system, such as multiple sclerosis, where frequency and
urgency may represent one of the early symptoms of the disease. Precipitous micturition
also occurs in brain lesions. Drugs such as Atropine or Probanthine may have some
transitory beneficial effect on reducing the hyperexcitability of the detrusor mechanism
but the best result can be achieved by systematic training of the patient to correlate
the amount of fluid intake with emptying the bladder at regular intervals which depend on
the degree of precipitancy. Change of temperature, in particular cold weather, may have
an adverse effect on precipitancy and increase incontinence. The wearing of a urinal may
be necessary in numerous cases of non-progressive incomplete cord lesions, at least
temporarily, to avoid anxiety and embarrassment until better control is achieved. How
ever, a greater number of patients with complete lesions will have to depend on wearing
a urinal permanently.
Electrical treatment of incontinence
This is still a very debatable problem. In Great Britain Caldwell (1963, 1967) was
pioneering in the field of electrical control using an implantable device, designed by the
Medical Research Connal's Sphincter Research Unit in Exeter. Alexander & Rowan
(1968) introduced an external electrode system for use in female patients, in which a
standard vaginal pessary served as a standard electrode carrier. Similar devices have been
reported by de Soldenhoff& McDonnell (1968) and Edwards (1971). Hopkinson (1971),
using intra-anal plug electrodes, reported his results of five years' experience on various
types of incontinence and claimed 53 per cent cures. However, others report control only
