Neurogenic Vesical Dysfunction an Experimental Study

Abstract

The nature and fundamental characteristics of the various types of neurogenic vesical dysfunction were studied in the 2 [female] following section of the hypogastric and pelvic nerves, by differential section of the anterior and posterior sacral nerve roots, and by transaction of the cauda equina and "spinal cord. The changes in vesical tone and vesical capacity were recorded by means of preoperative and postoperative cystometrograms while the concomitant changes in the upper part of the urinary tract were recorded by means of excretory urograms and retrograde cystograms. Three distinct types of dysfunction were observed. (1) The atonic bladder is the result of a lesion or lesions of the posterior sacral roots or posterior sacral root ganglia which seriously interfere with the normal transmission or sensory impulses from the bladder to the spinal cord. It is characterized by low intravesical pressure, large capacity, and complete absence of any waves of contraction in the cystometrogram. (2) The autonomous bladder is the result of a lesion or lesions of the sacral portion of the spinal cord, the cauda equina or the pelvic nerves (anterior sacral roots) which seriously interfere with normal motor in-nervation of the bladder. It is characterized by increased tone, decreased capacity and characteristic waves of autonomous contractions in the cystometrogram. Residual urine is usually present and incontinence may be of both an active and a passive variety. Voluntary control of urination is lost and vesical sensation usually is impaired. (3) The automatic, or reflex, bladder is the result of a lesion of the spinal cord which is situated above the sacral level and which interferes with the cortico-spinal pathways (influence of inhibition) to the urinary bladder. It is characterized by decreased capacity, increased tone, and characteristic waves of automatic, or reflex, contraction in the cystometrogram. Dilation of the ureters and kidneys usually was found in association with the autonomous type of neurogenic vesical dysfunction. No dilation of the upper part of the urinary tract was found in association with the automatic reflex type of neurogenic vesical dysfunction. Section of the hypogastric nerves and excision of the lumbar sympathetic ganglia result merely in a temporary de-crease in vesical capacity and a slight increase in vesical tone.