Suprapubic Puncture in the Treatment of Neurogenic Bladder

Abstract

The treatment of “cord bladder”, a disturbance of bladder function from disease or trauma of the spinal cord, can be a difficult problem. Until the recent publications of Munro, there was little physiological basis for whatever treatment was instituted. With the advent of tidal drainage and recognition of the various types or stages of a given cord bladder, more satisfactory results have been obtained.

In his excellent work on the cystometry of the bladder Munro^1,2 classifies “cord bladders” into four groups:

1. Atonic — characterized by retention and extreme distention from lack of detrusor tone, lack of any activity of the external urethral sphincter, and complete lack of emptying contractions.

2. Autonomous — the detrusor and internal sphincter musculature show signs of reciprocal action of varying degree. There is an increase in detrusor muscle tone, and an inability to store an appreciable amount of urine without leakage. The condition of this bladder represents the end result in destructive lesions of the sacral segments or cauda equina.

3. Hypertonic — an expression of an uncontrolled spinal segmental reflex, characterized by a markedly increased detrusor muscle tone, almost constantly present emptying contractions, low residual urine, and impairment of control of the external sphincter.

4. Normal cord bladders — in transecting lesions above the sacral segments, consisting of two types which differ largely only in their cystometric findings:

   1. (a)

      Uninhibited cord bladder — an apparently normal bladder which empties itself quite regularly. The detrusor tone is still somewhat increased, emptying contractions are rhythmical, the residual is low, and. . .