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Original communication| Volume 4, ISSUE 5, P649-662, November 1938

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The treatment of paralytic bladder in cases of spinal cord injury

DOI:https://doi.org/10.5555/uri:pii:S0039606038903812
The treatment of paralytic bladder in cases of spinal cord injury
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      Abstract

      • 1.
        I. It is judicious to treat each paralyzed bladder on sound urological principles.
        • 1.1.
          A. There are four effects on micturition to consider: retention, overflow incontinence, automaticity, and true incontinence. In cases of fracture above the lumbar center the first three occur in succession. An automatic bladder never develops as the late and final effect after fractures below this center, and incontinence may follow destruction of the cord at this level. Partial lesions and trauma by pressure or bruising effect slight changes from the normal, usually of short duration. The “spinal shock” of any lesion at any level causes an initial paralysis of the bladder with retention. Early development of automaticity is highly desirable, but it is possible in only one group. Some methods favor this outcome more than others. Therefore, the same indication for the treatment of retention at onset notwithstanding, consideration of the probable late effects presumed by a knowledge of the level and extent of the injury should influence the choice of method.
        • 1.2.
          B. Any method proves itself largely by reason of the precision and skill with which it is carried out. Some methods require more care and experience than others. Consideration of the fact that this care may be wanting also should influence the choice of method.
      • 2.
        II. It is impractical to treat all paralyzed bladders alike.
        • 2.1.
          A. Some do best if left alone or, at most, emptied regularly by manual expression. Others get along satisfactorily with retention catheters irrigated periodically or continuously (tidal); and still others require cystostomy for drainage.
        • 2.2.
          B. Urinary infection and bedsores foil the outcome to a maximum of over 80 per cent. The intent of all care, therefore, is to prevent or control these two evils.
        • 2.3.
          C. Noncatheterization, with manual expression and antiseptic therapy, is the one way to ward off urinary sepsis. When it works, it is the best method to hasten automaticity. It is useless and dangerous as a method to control infection. If infection is present, the choice between catheter per urethram, and cystostomy must be made at once. Even before infection takes place drainage by one means or the other often proves superior.
      • 3.
        III. The care of the bladder after injuries to the spinal cord should be prompt, precise, and farsighted. To be successful, rare judgment and constant attention are required. Most of these patients, in spite of all effort, die of or with severe urinary infection.
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      Article info

      Publication history

      Received: June 9, 1938

      Footnotes

      ☆Read before the American Academy of Orthopaedic Surgery, Los Angeles, Calif., Jan. 19, 1938.

      Identification

      DOI: https://doi.org/10.5555/uri:pii:S0039606038903812

      Copyright

      © 1938 Published by Elsevier Inc.

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