A 43-year-old woman was referred for evaluation and treatment of atonic bladder caused by a conus medullaris injury in July 2000. She had fallen from an elevated height, which resulted in a compression fracture of the L1 vertebra and subsequently complete paraplegia. The patient complained of urinary retention and anuria, which required insertion of an indwelling urinary catheter. As expected, a serious urinary infection had developed, for which antibiotic therapy was instituted. Surgical reconstruction of the bladder reflex pathway was scheduled and performed 4 months after the injury. At this time, the medial sural cutaneous nerve was cut and anastomosed with the T10 and S2 ventral roots (Fig. 8.2).

After the reconstructive procedure, the indwelling urinary catheter was kept in place for 1.5 years and caused multiple urinary system infections. At 2 years after the surgery, the patient experienced recovery of bladder storage and voiding functions. She could void by scratching her T10 dermatome. To date, this patient has been followed for 72 months and the urethral catheter has been removed. She has regained the sensation of bladder fullness, can contract the abdominal muscle, and is capable of complete urination without any difficulty. The total urinary output increased from 500 to 800 ml per day. According to the results of urodynamic analysis, the flow rate of patient’s maximal urine was 38 ml/s; urinary output, 596 ml/void; residual urine, 30 ml; vesical pressure, 145 cm H₂O; abdominal pressure, 31 cm H₂O; and detrusor pressure, 114 cm H₂O (Fig. 8.3). The detrusor had acquired the nerve reflex since the external sphincter was denervated. Hence, the recovery of urinary function was mainly contributed to detrusor contraction, instead of bladder compression through the abdominal muscles.