1036 Paralysis of the Bladder. 



2. Paralysis of the Bladder. 



By paralysis of the bladder is meant the inability to void 

 the urine voluntarily or to retain it. 



According to this definition those cases may not be included in 

 paralj-sis of the bladder in which purely mechanical factors have inter- 

 fered with the voiding of the urine or in which the psychic functioning 

 of the brain has ceased to be active. 



Etiology. A myopathic origin may be assumed for tran- 

 sitory paralysis of the Detrusor urinae, which is observed 

 occasionally in otherwise healthy animals when they were 

 obliged to retain the urine for a long time on account of pro- 

 tracted labor or because they were confined in a room. In 

 such cases the muscles of the bladder are stretched excessiveh^ 

 by the urine which has collected in the bladder in considerable 

 amount and thereby the power of contraction is reduced for 

 a time. A myopathic paresis of the bladder is also accountable 

 for the retention of urine which arises in exceptional cases 

 in inflammatory conditions of the walls of the bladder or in 

 deep-seated inflammations of the contiguous organs, especially 

 the peritoneum. By passing to the muscularis of the bladder, 

 the inflammatory process may diminish the contractility of 

 the muscles. In such cases it is, however, probably more often 

 an occlusion of the first urethral portion or a spasm of the 

 sphincter that causes the retention. 



A persistent paralysis of the bladder develops only in 

 certain diseases of the nervous system, especially in injuries 

 affecting the sacral and the posterior lumbar portion of the 

 cord and their nerve roots and nerves. Such affections are: 

 inflammation, contusion, hemorrhage in the conns mednllaris, 

 compression of the latter and of the related nerve roots in 

 the anterior portion of the sacral canal, during intervertebral 

 enchondrosis or pachjmieningitis ossificans; exceptionally the 

 trouble may occur in consequence of a new^-formation or of 

 an abscess. In horses it occurs rather often in inflammation 

 of the Cauda equina (combined paralysis of tail and sphincters). 

 A lesion outside of the vertebral canal of the nerves which 

 pass to the bladder has not been observed in animals,, nor 

 disease of the centers for the bladder muscles in the s}mipathetic 

 nerves of the pelvic cavity. In diseases of the spinal cord 

 above the posterior lumbar section, paralysis of the bladder 

 is found only in such cases in which the conductivity of the 

 centripetal and centrifugal tracts has been diminished or de- 

 stroyed. This may take place in contusion, inflammation and 

 compression of the cord. 



Pathogenesis. In addition to the ganglion cells within the 

 bladder wall itself the motility of the bladder is influenced 

 by sympathetic, spinal and cerebral centers. As an intimate 

 functional reciprocity develops between these centers in tlie 



