We followed 62 patients with complete suprasacral spinal cord injuries and detrusor-sphincter dyssynergia for at least 2 years. The patients were evaluated urodynamically at regular intervals and 50 per cent were subjected to external sphincterotomy, after which they were compared for the presence of bacteriuria and upper urinary tract changes. Patients on prolonged intermittent catheterization did as well as those who achieved balanced bladder function as a result of sphincterotomy.

This article describes findings from empirical research examining sterilization applications for minors made to the Family Court of Australia between 1992 and 1999. Original materials and written reports from “experts,” family members, and judicial officers are used to highlight the dominant discourse and themes. These are compared with historical characterizations of young women with disabilities used during the notorious eugenics period in the first half of the 20th century. The new ways of justifying sterilization use the sanitized language of “best interests,” silencing constructionist approaches to disability and gender issues. The new ways are reminiscent of the old ways of discrimination, prejudice, and violation.

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Significant bladder residual urine is secondary to pelvic floor skeletal muscle hypertonicity in some spinal cord injury patients with suprasacral or mixed lesions. Fifteen patients with residual urine volumes greater than 150 cc were treated with dantrolene sodium because of its ability to decrease skeletal muscle contractibility. All of the patients had urethral closure pressures greater than 100 cm. water. Of the 15 patients 8 benefited from dantrolene sodium therapy and were maintained on external condom urinary drainage. Five of these 8 patients required up to 600 mg. dantrolene sodium daily to affect this result. The residual urine volume decreased to less than 100 cc and the post-therapy decrease in urethral pressure averaged 77 cm. water (49 per cent). The patients in the failure group (residual urine greater than 150 cc) had an average decrease in urethral pressure of 21 cm. water (16 per cent). Detrusor hyporeflexia possibly contributed to the failure rate. In summary, dantrolene sodium seems to be beneficial in some patients with external urinary sphincter hypertonicity. However, it will not supplant external sphincterotomy in the more complete male spinal cord injury patient in whom reflex incontinence is of minimal concern. Dantrolene sodium could be an ideal treatment of patients with incomplete neurologic lesions in whom continence might be preserved. The drug will have to be effective at low doses to obviate the major side effect of over-all muscle weakness.

Australian sterilisation law is defective because it does little to prevent the unauthorised sterilisation of children with intellectual disabilities. This paper supports the urgent need for prescriptive legislation and procedural reform to ensure the protection of the rights and best interests of these children. It argues that non‐adversarial approaches like the provision of information, advice, and support services are essential for the promotion of informed decision‐making by families, and to ensure that irreversible and invasive procedures are of ‘last resort’, and in the ‘best interests’ of the child. It describes a ‘cooperative arrangement’ in Queensland where key stakeholders have successfully identified a practical, less intrusive service oriented approach for addressing these highly sensitive and ethically contentious matters.