The History of the Role of Urologists in the Spinal Units in the United Kingdom

which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Spinal injuries have been known since antiquity and until the 20 th century, carried an inevitable fatal prognosis. Patients died either immediately from their intercurrent injuries and acute fulminating urinary tract infections, or they died in the following weeks from chronic pyelo-nephritis and pressure sores. Any treatment was pallia-tive, easing the patient's pathway to the grave. Today, as a result of pioneering work started prior to the Second World War by Donald Munro in the United States and during the Second World War by Ludwig Gutt-mann in the United Kingdom, the situation has changed remarkably, provided the patient with an acute spinal injury is admitted to a specialised centre where all the facilities to investigate and treat the patient comprehensively are available (1). Dedicated medical staff, comprising of a neurosurgeon, an orthopaedic surgeon, a plastic surgeon, a urological surgeon, a physical medicine consultant , and a radiologist, should work as a team with one consultant taking the lead and assuming overall responsibility for the patients. Provided there is appropriate radiological backup with CT and MRI scanners and the support of the intensive care unit with devoted occupational and physiotherapy staff, and on discharge, follow up is maintained under the care of the unit, the patient can expect a near normal life expectancy and return to gainful employment (1). It is apparent that the management of the paralysed bladder is paramount to the successful management of the patient. How this evolved is of particular interest and there are many lessons to be learned. Prior to the first World War, traumatic spinal injuries were rare. It took Hulke 24 years to accumulate data on 33 patients, 22 of whom were under his care (2). Warfare provided a unique series of casualties but there were no survivors from the Crimean War and 75% of the spinal injury patients From the Boer War died within a few weeks (2, 3). The First World War was a conflict of unprecedented proportions with 1,662,625 casualties seen in the British Army alone and the majority of paraplegics died soon after injury. Of those who survived long enough to reach a base hospital Implication for health policy/practice/research/medical education: This article provides the historical background to the modern management of the bladder in paraplegic patients.