Diversion of the urine in paraplegia

Abstract

Liverpool [T was Isak Dineson who said in Seven Gothic Tales ' ... What is man, when you come to think of him, but a minutely set, ingenious machine for turning with infinite artfulness, the red wine of Shiraz into urine?' This may be a somewhat cynical view of life, but those clinicians dealing with patients with paraplegia are fully conscious of the great importance of the secretory function, and of the fact that should death occur at a later stage the cause is usually renal failure. It would appear that the problem of diversion in the adult is somewhat different to that in the child and it is the purpose of this communication to deal with adults only. There is, however, no doubt that diversion of the urine is rarely needed in the adult neurogenic bladder, and over many years at the Southport Centre the writer has carried out this surgical procedure on few occasions only (20 patients out of a total of 567 cases since 1948).

Long-term urethral catheterisation after spinal injury

“…Infection can usually be controlled by antibiotic therapy, by abolishing residual urine and by removing urinary calculi, but the establishment of free drainage of the urinary tract is rather more difficult and may involve the use of bladder training, carbachol and surgical procedures including transurethral resection of the bladder neck and external sphincter. It has also been suggested that there may be a place for division of the pudendal or sacral nerves (Ross, 1956;Misak, et al, 1962).…”

“…Suprapubic cystotomy does not provide dependant drainage, anterior transposition of the urethra has a limited application and cutaneous vesi costomy is not generally successful (Krahn, Morales and Hotchkiss, 1964). Urinary diversion, though frequently advised in the past, is not without mortality and morbidity (Creevy, 1960;Bowles, Cordonnier and Parsons, 1964), and is probably best avoided except in the patients with progressive deterioration of renal function associated with obstruction and persistent infection (Ross, 1967).…”