STUDIES ON INCONTINENCE IN PARAPLEGIC PATIENTS

The incontinence in the paraplegics was studied with direct cystometry and the recording of integrating curve of incontinence urine volume on the supine resting posture about 18 males.<br>The pattern of the neurogenic bladder was analysed on the excretory cystometry (Nakajima. 1960). The urine in the incontinent was collected to a cylinder, the pressure of the urine was recorded electrically. The recorded curve displayed the integrated volume, frequency, interval and duration of the incontinence (Incontinogram).<br>The above incontinogram and direct cystometrogram were recorded through the trocar suprapubic cystostomy simulutaneously.<br>Results<br>1) The cystometry through the urethral catheter (excretory cystometry) was compared with the direct cystometry. The patterns of the neurogenic bladder were essentially almost same in each recording method. But in the automatic bladder, the height and width of wave were smaller on the direct cystometry, because of it easy incontinence.<br>In the case of the autonomous bladder, the intravesical pressure rose to some extent despite of incontinence.<br>The progressive ascending pressure curve reached to thirty centimeter H₂O or more at the laps of time, and it retained on the same level.<br>2) As the incontinence of the automatic bladder was a sort of reflex micturition, considerable volume was evacuated by the automatic contracted wave of the duration of 1-2 minutes, when the bladder content was reached above the certain fixt content.<br>The automatic wave was induced mainly as a consequence of cough, movement or spasm of the lower extremities.<br>3) Incontinence of the autonomous bladder was a dribbling type. It began when the bladder content was reached to some fixt volume. The content continued to increase in spite of the dribbling untill to reach the certain capacity.<br>After this, it resulted in the overflow type incontinence kept by the balance of in-and outflow of the bladder.<br>4) Incontinence of the autonomo-automatic bladder was mixed type, namely automatic typd reflex micturition preceded the appearance of the autonomous type incontinence.<br>After the repeated reflex incontinence in the first half course, it has shown two forms of conditions in the last half; one was the dribbling type only, the other was the continuous dribbling superimposed with the intermittent reflex type incontinence.<br>5) Urethral resistance at the time of incontinence was calculated by the direct cystoometry and the flow rate of incontinence. The values did not show any constant tendency in the same patient, and it had not any relations with retrograde urethral resistance.<br>6) Incontinence was inhibited temporarily by procaine anesthesia of the bladder mucosa. The inhibition was considered to be resulted by the increase of the vesical capacity.<br>7) T. T. F. D. (Thiamine tetrahydrofurfuryl disulfide) was effective in two out of four cases for the inhibition of the automatic waves and for the increasing of bladder capacity at the first occurarnce of incontinence. The muximum voluntary intravesical pressure was raised in all four cases.