An attempt to understand and to treat voiding dysfunctions during rehabilitation of the bladder in spinal cord injury patients.

An attempt to understand and treat dysfunctions during bladder rehabilitation in 150 spinal cord injury patients is presented. The 25 problem patients were further analyzed to identify and manage the dysfunctional bladder and bladder neck, dyssenergic pelvic floor, vesicoureteral reflux, areflexic detrusor muscle and also to discontinue prolonged intermittent catheterization. The initial excellent results with a modified approach to sphincterotomy and the bladder neck operation in 15 patients are presented. Early recognition of patients in whom intermittent catheterization may not be successful will allow one to intervene and establish an early catheter-free status. A new concept of the existence of receptors in the posterior urethra has been postulated.