Management of vesical dysfunction of neurosyphilis by transurethral resection of the vesical neck.

When bladder function is permanently disorganized by syphilis of the central nervous system, measures may have to be taken for the relief of symptoms, elimination of residual urine, and prevention or eradication of urinary sepsis. In the past, there were no means by which these aims could be satisfactorily achieved. In recent years, the successful management of cord bladder by transurethral resection of the vesical neck has been reported in many papers published abroad. There is little reference to this method of treatment in the British literature, and a brief review of the published work with the results of transurethral resection of the vesical neck in three cases of cord bladder of luetic origin may be of interest. Although it cannot be said that this method of managing cord bladder has a sound rationale, the results so far obtained support the contention upon which it is based, namely, that retention of urine in cord bladder is partly caused by obstruction at the vesical neck. In the first place, urinary retention in cord bladder appears to result from inability of the involuntary muscle of the bladder wall, the detrusor urinae, to develop and maintain powerful contractions long enough for complete emptying of the bladder. In the autonomous and automatic bladders, this failure of detrusor contractions is due either to the bladder being isolated from a centre in the midbrain which is responsible for prolonged contractions of bladder muscle (Langworthy and Kolb, 1933), or to there being insufficient spinal segmental pathways for efficient correlation of the various detrusor impulses (Denny-Brown and Robertson, 1 933b). In the atonic bladder, seen typically in tabes dorsalis, detrusor inefficiency appears to result from lack of afferent stimuli and loss of tone.