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May 19, 1951, Vol 146, No. 3 >
Other Articles | May 19, 1951

UROLOGICAL ASPECTS OF REHABILITATION IN SPINAL CORD INJURIES

Ernest Bors, M.D.
[+] Author Affiliations

Read in the Symposium on Physical Medicine and Rehabilitation for Paraplegics before the Section on Physical Medicine and Rehabilitation at the Ninety-Ninth Annual Session of the American Medical Association, San Francisco, June 30, 1950.

Reviewed in the Veterans Administration and published with the approval of the Chief Medical Director. The statements and conclusions published by the author are the result of his own study and do not necessarily reflect the opinion or policy of the Veterans Administration.


Van Nuys, Calif.

From the Paraplegic Service of Veterans Administration Hospital, and the Department of Surgery, University of California at Los Angeles School of Medicine.


JAMA. 1951;146(3):225-229. doi:10.1001/jama.1951.03670030003002
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References

The goal of rehabilitation of the paraplegic patient is threefold: medical, physical and vocational-industrial. The urological part of the medical rehabilitation and physical rehabilitation must start as a synchronized effort immediately after the injury.

In World War I only 20 per cent of the spinal cord casualties reached the United States, while 80 per cent died overseas. This ratio was dramatically reversed in World War II, with a survival rate of 80 to 88 per cent of the returning soldiers.1 Table 1 illustrates the high mortality from genitourinary causes in World War I as contrasted with the low incidence of genitourinary deaths in World War II. This progress must be attributed to the improved understanding of the pathophysiology of the neurogenic bladder and its associated complications and to the advent of sulfonamide drugs and antibiotics.

BLADDER PHYSIOLOGY  The function of the bladder consists in storage and elimination. Elimination starts

REFERENCES

1 +
Prather, G. C.: Urological Aspects of Spinal Cord Injuries , Springfield, Illinois, Charles C Thomas, Publisher, 1949;.
2 +
Prather, G. C.: Urological Aspects of Spinal Cord Injuries , Springfield, Ill., Charles C Thomas, Publisher, 1949;.
3 +
Prather, G. C.: Urological Aspects of Spinal Cord Injuries , Springfield, Ill., Charles C Thomas, Publisher, 1949;.
4 +
Prather, G. C.: Urological Aspects of Spinal Cord Injuries , Springfield, Ill., Charles C Thomas, Publisher, 1949;.
5 +
Prather, G. C.:  Spinal Cord Injuries: Care of the Bladder , J. Urol. 57: 15, 1947;.
6 +
Bors, E.: Spinal Cord Injuries, United States Veterans Admin. Tech. Bull. TB10-503, Dec. 15, 1948.
7 +
These bibliographic references are omitted from The Journal because of lack of space but are included in the author's reprints.
8 +
Solution "M" has the following constituents: citric acid monohydrate, 32.25 Gm.; sodium carbonate, 8.84 Gm.; anhydrous magnesium oxide, 3.84 Gm., and sterile distilled water to make 1,000 cc. It differs from solution "G" in that it contains 8.84 Gm. of sodium carbonate instead of 4.37 Gm. of sodium bicarbonate. It is less irritating, less solvent and less acid. It is used in dissolving stones in the bladder or renal pelvis by continuous irrigation.
9 +
Bors, E.: Presented before the Conference on Transverse Myelitis, Hammond General Hospital, Ninth Service Command, Army Service Forces, United States War Department, Modesto, Calif., June 24-25, 1945.
10 +
Huggins, C.; Walker, A. E., and Noonan, W. J.:  Sympathetic and Pudendal Neurectomy for Vesical Atony , J. Urol. 41:696, 1939;.
11 +
Emmett and others.3j
12 +
Wesson, M. B.:  Anatomical, Embryological, Physiological Studies of the Trigone and Neck of the Bladder , J. Urol. 4: 279, 1920;.
13 +
Young, H. H., and Wesson, M. B.:  The Anatomy and Surgery of the Trigone , Arch. Surg. 3:1, 1921;.
14 +
McCrea, E. D.:  The Musculature of the Bladder , Proc. Roy. Soc. Med. (Sect. Urol.) 19: 35, 1926;.
15 +
Learmonth, J. R.:  A Contribution to the Neurophysiology of the Urinary Bladder in Man , Brain 54: 147, 1931;
16 +
 Neurosurgery in the Treatment of Diseases in the Urinary Bladder: Ill. The Treatment of Certain Types of Vesical Paralysis , J. Urol. 26: 229, 1931;.
17 +
Bors, E.: The Action of the Pudendal Nerve on the Vesical Neck and Its Significance for the Restoration of Balance of Bladder Function in Spinal Cord Injuries, read before the San Francisco Neurological Society and the Southern California Neurosurgical Society, Pebble Beach, Calif., Feb. 9-11, 1950.
18 +
Nesbit, R. M.: Personal communication to the author
19 +
Higgins and others.5b
20 +
Muellner, S. R., and Fleischner, F. G.:  Normal and Abnormal Micturition: A Study of Bladder Behavior by Means of the Fluoroscope , J. Urol. 61: 233, 1947;.
21 +
Hoen, T. I., in discussion on The Urological Problem, presented before the Conference on Spinal Cord Injuries, Second Service Command, Army Service Forces, War Department, October 20, 1945.
22 +
Meirowsky, A. M.; Scheibert, C. D., and Hinchey, T. R.:  Studies of the Sacral Reflex Arc in Paraplegia: I. Responses of the Bladder to Surgical Elimination of Sacral Nerve Impulses by Rhizotomy , J. Neurosurg. 7:33, 1950;
23 +
 Studies of the Sacral Reflex Arc in Paraplegia: II. Different Sacral Neurotomy and Operative Method , MeirowskyJ. Neurosurg. 7:39, 1950;.
24 +
Sheldon, C. H., and Bors, E.:  Subarachnoid Alcohol Block in Paraplegia: Its Beneficial Effect on Mass Reflexes and Bladder Dysfunction , J. Neurosurg. 5:385, 1948;.
25 +
Guttmann, L., and Whitteridge, D.:  Effects of Bladder Distention on Autonomic Mechanisms After Spinal Cord Injuries , Brain 70:361, 1947;.
26 +
Thompson, C. E., and Witham, A. C.:  Paroxysmal Hypertension in Spinal Cord Injuries , New England J. Med. 239:291, 1948;.
27 +
Flocks, R. H.:  "Early" Calcium Urolithiasis , J. A. M. A. 130:913 ( (April 6) ) 1946;.
28 +
Freeman, L. W.:  The Metabolism of Calcium in Patients with Spinal Cord Injuries , Ann. Surg. 129: 177, 1949;.
29 +
Abramson, A. S.:  Bone Disturbances in Injuries to the Spinal Cord and Cauda Equina (Paraplegia): Their Prevention by Ambulation , J. Bone & Joint Surg. 30-A:982, 1948;.
30 +
Bors, E.:  Intravenous Urography with Consideration of Different Postures of the Body , Ztschr. Urol. 35:893, 1931;.
31 +
Bors, E.:  Perception of Gonadal Pain in Paraplegics , Arch. Neurol. & Psychiat. , to be published.
32 +
Weinberg, J. A.:  Topical Penicillin Treatment of Established Infection in Compound Fracture Wounds , Surg., Gynec. & Obst. 82: 557, 1946;.
33 +
Derra, E., and Nadermann, E.:  Parossale Verkalkungen an den Beinen bei Paraplegikern Nach Wirbelbrüchen , Zentralbl. Chir. 69:758, 1942;.
34 +
Huber, K., and Kyrle, P.:  Über das Auftreten von Harrnöhrenfisteln bei Rückenmarkschädigungen , Wien. kiln. Wchnschr. 55: 426, 1942;.
35 +
Comarr, A. E., and Bors, E.: Urethral Pathology in Paraplegic Patients, to be published.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Prather, G. C.: Urological Aspects of Spinal Cord Injuries , Springfield, Illinois, Charles C Thomas, Publisher, 1949;.
2 +
Prather, G. C.: Urological Aspects of Spinal Cord Injuries , Springfield, Ill., Charles C Thomas, Publisher, 1949;.
3 +
Prather, G. C.: Urological Aspects of Spinal Cord Injuries , Springfield, Ill., Charles C Thomas, Publisher, 1949;.
4 +
Prather, G. C.: Urological Aspects of Spinal Cord Injuries , Springfield, Ill., Charles C Thomas, Publisher, 1949;.
5 +
Prather, G. C.:  Spinal Cord Injuries: Care of the Bladder , J. Urol. 57: 15, 1947;.
6 +
Bors, E.: Spinal Cord Injuries, United States Veterans Admin. Tech. Bull. TB10-503, Dec. 15, 1948.
7 +
These bibliographic references are omitted from The Journal because of lack of space but are included in the author's reprints.
8 +
Solution "M" has the following constituents: citric acid monohydrate, 32.25 Gm.; sodium carbonate, 8.84 Gm.; anhydrous magnesium oxide, 3.84 Gm., and sterile distilled water to make 1,000 cc. It differs from solution "G" in that it contains 8.84 Gm. of sodium carbonate instead of 4.37 Gm. of sodium bicarbonate. It is less irritating, less solvent and less acid. It is used in dissolving stones in the bladder or renal pelvis by continuous irrigation.
9 +
Bors, E.: Presented before the Conference on Transverse Myelitis, Hammond General Hospital, Ninth Service Command, Army Service Forces, United States War Department, Modesto, Calif., June 24-25, 1945.
10 +
Huggins, C.; Walker, A. E., and Noonan, W. J.:  Sympathetic and Pudendal Neurectomy for Vesical Atony , J. Urol. 41:696, 1939;.
11 +
Emmett and others.3j
12 +
Wesson, M. B.:  Anatomical, Embryological, Physiological Studies of the Trigone and Neck of the Bladder , J. Urol. 4: 279, 1920;.
13 +
Young, H. H., and Wesson, M. B.:  The Anatomy and Surgery of the Trigone , Arch. Surg. 3:1, 1921;.
14 +
McCrea, E. D.:  The Musculature of the Bladder , Proc. Roy. Soc. Med. (Sect. Urol.) 19: 35, 1926;.
15 +
Learmonth, J. R.:  A Contribution to the Neurophysiology of the Urinary Bladder in Man , Brain 54: 147, 1931;
16 +
 Neurosurgery in the Treatment of Diseases in the Urinary Bladder: Ill. The Treatment of Certain Types of Vesical Paralysis , J. Urol. 26: 229, 1931;.
17 +
Bors, E.: The Action of the Pudendal Nerve on the Vesical Neck and Its Significance for the Restoration of Balance of Bladder Function in Spinal Cord Injuries, read before the San Francisco Neurological Society and the Southern California Neurosurgical Society, Pebble Beach, Calif., Feb. 9-11, 1950.
18 +
Nesbit, R. M.: Personal communication to the author
19 +
Higgins and others.5b
20 +
Muellner, S. R., and Fleischner, F. G.:  Normal and Abnormal Micturition: A Study of Bladder Behavior by Means of the Fluoroscope , J. Urol. 61: 233, 1947;.
21 +
Hoen, T. I., in discussion on The Urological Problem, presented before the Conference on Spinal Cord Injuries, Second Service Command, Army Service Forces, War Department, October 20, 1945.
22 +
Meirowsky, A. M.; Scheibert, C. D., and Hinchey, T. R.:  Studies of the Sacral Reflex Arc in Paraplegia: I. Responses of the Bladder to Surgical Elimination of Sacral Nerve Impulses by Rhizotomy , J. Neurosurg. 7:33, 1950;
23 +
 Studies of the Sacral Reflex Arc in Paraplegia: II. Different Sacral Neurotomy and Operative Method , MeirowskyJ. Neurosurg. 7:39, 1950;.
24 +
Sheldon, C. H., and Bors, E.:  Subarachnoid Alcohol Block in Paraplegia: Its Beneficial Effect on Mass Reflexes and Bladder Dysfunction , J. Neurosurg. 5:385, 1948;.
25 +
Guttmann, L., and Whitteridge, D.:  Effects of Bladder Distention on Autonomic Mechanisms After Spinal Cord Injuries , Brain 70:361, 1947;.
26 +
Thompson, C. E., and Witham, A. C.:  Paroxysmal Hypertension in Spinal Cord Injuries , New England J. Med. 239:291, 1948;.
27 +
Flocks, R. H.:  "Early" Calcium Urolithiasis , J. A. M. A. 130:913 ( (April 6) ) 1946;.
28 +
Freeman, L. W.:  The Metabolism of Calcium in Patients with Spinal Cord Injuries , Ann. Surg. 129: 177, 1949;.
29 +
Abramson, A. S.:  Bone Disturbances in Injuries to the Spinal Cord and Cauda Equina (Paraplegia): Their Prevention by Ambulation , J. Bone & Joint Surg. 30-A:982, 1948;.
30 +
Bors, E.:  Intravenous Urography with Consideration of Different Postures of the Body , Ztschr. Urol. 35:893, 1931;.
31 +
Bors, E.:  Perception of Gonadal Pain in Paraplegics , Arch. Neurol. & Psychiat. , to be published.
32 +
Weinberg, J. A.:  Topical Penicillin Treatment of Established Infection in Compound Fracture Wounds , Surg., Gynec. & Obst. 82: 557, 1946;.
33 +
Derra, E., and Nadermann, E.:  Parossale Verkalkungen an den Beinen bei Paraplegikern Nach Wirbelbrüchen , Zentralbl. Chir. 69:758, 1942;.
34 +
Huber, K., and Kyrle, P.:  Über das Auftreten von Harrnöhrenfisteln bei Rückenmarkschädigungen , Wien. kiln. Wchnschr. 55: 426, 1942;.
35 +
Comarr, A. E., and Bors, E.: Urethral Pathology in Paraplegic Patients, to be published.

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