The Bladder in Paraplegia
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چکیده
Physiology There is little difference of opinion on the main physiological points. The micturition centre in the sacral cord, opposite the twelfth dorsal and first lumbar vertebral bodies, controls the normal filling of the bladder, reacts to a stretch in the muscle and empties the bladder, though perhaps not quite completely, in one sustained contraction. The afferent and efferent impulses pass through the nervi-erigentes of the second, third and fourth sacral nerves. The sympathetic nerves have no significant part in micturition, and their section in the paralysed patient merely removes a minor sensation of tightness in the bladder region and perhaps pain, but has no effect on the motor side of the act. The voluntary control of micturition descends' from the cortex in the lateral columns. Unilateral interruption does not affect control. This control is partly inhibitory and partly an ill-understood mechanism to initiate micturition, which is thought to occur as a result of an initial voluntary relaxation of the perineal muscles, with the exception of the external sphincter of the urethra which can be voluntarily contracted but not voluntarily relaxed.
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تاریخ انتشار 2008