The role of urodynamics in the management of spinal cord injured patients.

The urological management of 1126 consecutive patients treated at the Mersey Regional Spinal Injuries Centre between 1947 and 1983 is reviewed. It is concluded that when urodynamics is included in the urological investigative profile, in addition to clinical, biochemical, intravenous urographic and cystourethrographic assessments, then treatment failure is less likely.

Division of the external urethral sphincter and potency in spinal cord injury patients.

Endoscopic biopsy of the external urethral sphincter (internal membranous urethrotomy) was used first in England in 1956. A total of 258 patients underwent this operation for relief of outflow obstruction in the neuropathic bladder between 1956 and 1975. Recently, reports of postoperative impotence had appeared in the literature. A prospective study of 160 men undergoing division of the external urethral sphincter between 1975 and 1981 was done to determine if there was any effect on sexual function and to reassess the long-term results of the operation. Impotence has not been documented in any of these 418 patients. This study confirms previous reports on the reliability and simplicity of the operation.

Paraplegia and prostatic cancer.

When paraplegia occurs as a result of malignant disease, it generally means that the patient's survival is limited to a few months. The exceptions to this rule include patients with paraplegia or quadraplegia as a result of metastases from carcinoma of the prostate. This study concerns 24 men with paraplegia, 20 of whom lived for over 5 years following the onset of paralysis, 18 being rehabilitated. The prostatic cause of paralysis may not be obvious at the first, and conventional X-rays of the spine may be negative. The serum acid phosphatase was raised in several cases, confirmation of the diagnosis could either be made by biopsy of the prostate gland or, if laminectomy is performed, by examining the tissue that compresses the spinal cord. Laminectomy is recommended only in patients with rapidly advancing neurological signs. The treatment of choice is orchidectomy rather than hormonal treatment in the elderly age group, as oestrogens cause cardio-vascular complications.

The long term results of transurethral division of the external urethral sphincter in the neuropathic urethra with reference to potency.

The operation of endoscopic biopsy of the external urethral (internal membranous urethrotomy) was first used in England in 1957. Currently the total of 322 patients had this operation for relief of outflow tract obstruction in the neuropathic bladder. In recent years reports of post-operative impotence had appeared in the literature. This is a prospective study of 143 men undergoing division of the external urethral sphincter to determine if there was any effect on sexual function as well as assessing again the long term results of the operation. There has been no case of impotence in this prospective study of 143 patients, nor has it been documented in any of the 322 cases treated from 1956 to 1980. This brief study confirms previous reports on the reliability and simplicity of the operation.

Critical evaluation of direct vision urethrotomy by urine flow measurement.

Fifty-two male patients were studied prospectively to assess the results of direct vision urethrotomy in the treatment of urethral strictures. The prognosis was found to be significantly worse in those patients who had received extensive previous treatment. A catheter is recommended for at least 3 days and for 4 weeks in patients who have had minimal previous treatment or who have impaired detrusor function. The use of a urine flowmeter is essential for determining the success of treatment and stricture recurrence. Measurement of the recurrence-free period is important for assessing progressive improvement following repeat urethrotomy and for determining which patients cannot be cured by direct vision urethrotomy.

Transverse fractures of the sacrum. A report of six cases.

The diagnosis of transverse sacral fracture was made in six patients. All patients initially had evidence of urinary retention, a decrease in anal sphincter tone, or both. Diagnostic confirmation was established by tomography in four patients and by cystometric examination in two. All patients who had transverse sacral fractures with displacement of the fragments had resolution of their neurological deficit following posterior sacral laminectomy and decompression.

Scrotal flap urethroplasty in the treatment of carcinoma of the penis.

Another use for the scrotal skin flap is described. It is an ideal method for dealing with carcinoma of the penis and prevents meatal stricture. It may be used to provide permanent urethrostomy in cases of chronic complicated urethral stricture where other types of operative treatment are unacceptable to the patient. It is recommended for use in situations where follow-up is difficult.

A cervical spinal cord injury following chiropractic manipulation.

A case is presented of a permanent C4 tetraplegia following chiropractic manipulation of a patient with ankylosing spondylitis. The pertinent literature is reviewed.

Urological management in onon-traumatic paraplegia: disc protrusions, multiple sclerosis and spinal metastases.

The urological management in non-traumatic paraplegia differs little from the management of the traumatic case; a policy of conservative optimism is adopted, particularly in dealing with multiple sclerosis and certain malignancies.