Prostato-cystopexy for a paraplegic case with an inactive bladder and perineum

Abstract

THE combination of an easily distending lower motor neuron bladder and an atonic pelvic floor can result in a total impossibility, in certain cases, of voiding without surgical interference. In most cases, a single, or repeated T. U.R., of the bladder neck, is sufficient. However, if this, or these, should fail, the cause of retention must be found out, and in some cases, such procedures as an Y-V prostato-urethroplasty, or even electrostimulation, have been advocated to avoid a permanent indwelling catheter. In true L.M.N. lesions the missing contraction of the detrusor is replaced by abdominal strain, associated, or not, by 'Crede pressure'. This is sufficient as long as the internal sphincter is permeable. When this is not, the combination of backand down-tilting of the bladder base, and FIG. I Case report, Male, aged 45. Complete permanent flaccid paraplegia, below TI I on the right, LIon the left, due to communitive fracture of LI .

Elongation of the active anterior wall of the uro-genital pelvic diaphragm, a late unusual complication of paraplegia

“…Other similar disturbances have been accounted for in the literature (Dollfus et al, 1972;Jurascheck et al, 1974;Archimbaud, 1974;Madersbacher, 1977) but for LMN lesions only. One must be alerted to these insidious changes and a dynamic urinary check-up must be performed with this type of mechanical dysuria in mind, even in UMNL.…”

“…Furthermore the stretching of the pubo vesical ligaments will enhance this phenomenon even more. We have published such a type of obstruction in a LMN lesion (Figs I and 2) (Juras check & Dollfus, 1972). This particular problem was solved by performing a prostato-cystopexy (Fig.…”

Surgical treatment of the static perineal modifications in spinal cord or cauda equina lesions

“…Figure 4 Voding cysto-urethrogram, in 1979,8 years after the first operation (published in Paraplegia, Dollfus et al, 1972). No residual urine.…”

“…The mechanism of the phenomenon is very particular and rare in man. It has been described elsewhere (Dollfus et at., 1972) (Fig. 1).…”

From intermittent catheterisation to catheter freedom via urodynamics: a tribute to Sir Ludwig Guttmann

“…However, in some instances fibrotic stenosis of the sphincter in cases of long-standing spinal cord injury (Cukier et al,197 1) or overactivity of the sympathetic system with ensuing contraction of the smooth urethral muscles may explain why some of these patients disclose a bladder neck widely open on straining but cannot, however, empty their bladder contents properly (Abel, Gibbon, Jameson & Krishnan, 1974). Mechanical kinking at the level of the prostato-membranous junction during straining may be another cause of obstruction in some other cases (Dollfus, Juraschek, Jacob-Chia & Peter, 1972).…”