CENTRAI. CONIROI. Ol' IIIK Ill.AnOl^K 



I -' I :? 



10 20 30 40 50 



INTRAVESICAL VOLUME IN 0.(1 



20 40 60 80 100 120 140 160 



VOLUME - CUBIC CENTIMETERS 



FIG. lo. Cystoinctrograins lioni a dcji; with iiiictuiiUon [nr- 

 \ontcd by general anesthesia and sacral root block (•). Crosses 

 show the prcssuic-\aluine relation 39 days after both ureters 

 were transplanted to exterior of the body- (I'Vom Vecncina et 

 al. (34)-] 



HG. 8. Graph showing cystometrograni following supra- 

 coUicular decerebration (SVP.D) and three successive cysto- 

 nielroRrams obtained at moderate pressures followinc; spinal 

 transection (.S7',, Wo, .S7':,). [From Tang & Ruch (jj)-! 



O 

 ~40 



X 



2 30 



O 



20 

 UJ 



cr: 



=> 10 

 CO 







o * 





i_ 



a: 

 a. 



20 40 SO eO 100 120 140 160 160 ZOC 



VOLUME IN CUBIC CENTIMETERS 



rif:. f). Bladder v(jluuie-pressure curves of cats anesthetized 

 with pentobarbital 13 days (X), 27 days (•) and 73 days ( + ) 

 after bilateral pelvic nerve section. Circles show the magnitude 

 of autonomous contraction 73 days after the operation. [Kmru 

 Carpenter & Root (5).] 



exaniinalion wliicli slioiilcl aid in the interpretation 

 of liuman neinogenic hlacicier cly.sfmictioii. 



Summary 



Experimental analysis shows that neural transec- 

 tions which strongly affect the excitaijility of tiie 

 micturition reflex arc arc witlioul effect on bladder 

 tone. Other conditions which would interrupt any 

 postulated parasympaliiclir or spinal reflex arc or a 



mural iJ!;any,lionic 'icllex" subserving tonus arc 

 equally wilhotU ellcci on detrusor tonus. On the 

 other hand, the ihrci- ijrocechiics which do depress or 

 elevate the tonus linil> ol ihc cyslonietrograin, 

 namely, repeated cysloinctric dclciniinaiions when 

 (he niicliirilioii rcllcx is in abeyance, chronic peU'ic 

 nerve section and clironic prevention ol bladder 

 filling, affect the physical stale of the vesicle wall, it 

 is therefore concluded lh:il bladder tonus is nol 

 neurogenic but relict ts the physical stale ol ihc 

 bladder wall, and that lonus changes appearing to be 

 neurogenic are mainly secondary lo neinogenic 

 alterations in the micturition reflex which is the 

 miardian of the |)hNsical slate ol the bladder wall. 

 This conclusion has implications lor cyslometrie 

 diagnosis and the interpretation and handling of 

 lunnan neurogenic bl.iddci dyshinclion. 



Pd/lidjiliysiologv oj lilaililn I miiis 111 Mini 



In man, as in the cat, (here is ex|)erimental and 

 presumptive evidence that the slight hypertonia from 

 acute neural insults and the more impressive hyper- 

 tonia from chronic insults are nol based on ,1 pnla- 

 ti\e reflex vesical loiuis mechanism. 



Using spinal anesthesia and TEA, Nesbit and his 

 co-workers (26, 27) have examined human cases of 

 acute and chronic spinal transection and a variety 

 of cases of other neurogenic bladder dysfunctions, 

 and the results agree entirely with ihe animal experi- 

 ments cited above. Therefore it can be concluded 

 that hypotonia in man reflects, not the state ol a 

 tonic reflex, but ihe promptness of catheleri/ation 



