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Pressure sores in the sitting paraplegic patient can delay rehabilitation by weeks or months, or can lead to the patient's permanent confinement to bed. This paper describes a method of redistributing the pressure loading on the sitting area so that pressure sores are unlikely to occur. In addition, a clinical approach which increases the patient's awareness of the problem is outlined and case histories and clinical results are described.

A total of 515 patients with spinal cord injuries were admitted to the Conradie Hospital's Spinal Cord Injuries Centre during a 3-year period from September 1974 to September 1977. Intermittent catheterization was used for urinary drainage in all patients with incomplete lesions as initially assessed neurologically, and indwelling catheterization in those with complete lesions. Transcutaneous suprapubic Bonnano (stab) continuous catheter drainage was used in a random group of 24 male patients with complete neurological lesions. The majority of the patients were admitted within 24 hours of injury. The follow-up period varied from 1 to 4 years. At 3 months more than 50% of patients had a balanced neurogenic bladder and were catheter-free. At 12 months 19% of patients were still catheter-dependent for reasons explained. Bladder outlet operations were more frequent among patients with thoracic lesions and were indicated 3 times more often in patients with complete neurological lesions. Bladder outlet operations were performed on 8.6% of patients. Only 5 patients (1%) required permanent urinary diversion. A urodynamic work-up is no longer regarded as merely a research tool in the investigation of patients with neurogenic bladder dysfunction. Both urodynamic and videoradiological techniques are a prerequisite to proper management of the neurogenic urinary tract.

Patients with spinal cord stabwounds accounted for over one-quarter of the more than 1 600 patients with spinal cord injury admitted to this unit during 13 years. Over half the lesions were of the Brown-Séquard type. Functional recovery was good in nearly two-thirds of patients. The principles of treatment are discussed.