Neurogenic Bladder Associated with Brain Tumors

Abstract

Until fairly recently, the top level for the control of the autonomic functions of the body has been assumed to be the basal ganglia of the brain. The work of experimental physiologists, particularly Sherrington, Denney-Brown, and Robertson in England, Fulton, Bucy, Langworthy, and Kolb in America has proved conclusively the existence of autonomic representation in the cerebral cortex. These highest autonomic centers are located in the cortex of the frontal lobes and they exert a governing effect on the centers in the hypothalamus and medulla which regulate visceral activity. Blood vessel tone, glandular secretions, sweating, and gastro-intestinal motility are a few of the visceral functions which have been proved to be definitely under the control of the frontal lobes of the brain.

In a study on the physiology of micturition in man, Denney-Brown and Graeme Robertson observed the variations in intravesical pressure which occur with increasing distention of the bladder. They concluded that apart from a faint background of maintained tonic activity, spontaneous vesical activity takes the form of waves of contraction appearing in rhythmical progression. An effort to void evokes powerful contractions of the bladder, whereas a voluntary effort of restraint completely inhibits the nervous discharges responsible for spontaneous vesical activity.

In pursuing the center for micturition cephalad, Longworthy and Kolb studied intravesical pressures in normal animals and in animals with sections through the brain stem at various levels. They first established the volume of contents necessary to induce reflex micturition in the intact animal. They found this to. . .