THE vesical dysfunction which follows injury or disease of the spinal cord or cauda equina has always presented a problem. The subject received much attention during the recent war and the many civilian accidents today which produce cord injury make it a continuing problem.
In past years the lot of the patient with a neurogenic bladder was unfortunate. If he failed to develop useful automatic control it became necessary for him to wear an undesirable rubber incontinence bag or to be given a permanent cystostomy. In the past decade following the reports of Braasch and Thompson1 and Emmett,2 transurethral resection of the vesical neck has been employed successfully to relieve the major annoyances of neurogenic bladder.
Certain basic facts regarding the anatomy and physiology of the bladder are important. It is composed of smooth or involuntary muscle. The so-called internal sphincter is made up of fibers of the detrusor muscle which are arranged in a circular manner around the bladder outlet. These muscles (detrusor and internal sphincter) receive their nerve supply through the pelvic nerves (parasympathetic) which arise from the second, third, and fourth sacral segments of the cord. Sensory fibers from the bladder are carried over the same nerves. Thus the pelvic nerves may be considered the nerves of micturition. The sympathetic system carries some sensory fibers for pain but the sympathetic nerves are not essential for bladder function which proceeds normally even after division of all sympathetic fibers.
The reflex arc for micturition therefore consists of sensory fibers. . .