The more prominent methods of initial bladder management following spinal cord injury have been presented. We feel (1) that conservative therapy is the best approach today; (2) that based on our statistics there is no justification to perform a Bricker operation or cutaneous vesicostomy initially after injury. If we are unable to create a balanced bladder function within a year, we do not have a catheter-phobia (realizing all the drawbacks of a catheter) and keep these patients on catheter drainage. Once the first year has passed and if one is still unable to create a catheter-free state, a substitute bladder or vesicostomy may, perhaps, be contemplated. However, only time will prove the justification of this attitude. Electrical stimulation and suprapubic aspiration need further observations. Obviously, one can not be dogmatic and state that the new techniques will not have a place in the armamentarium of neurological urology. But, we can be emphatic in requesting indications for the use of each procedure. There is nothing in medicine that does not require indications; there are hardly any procedures that can be applied routinely to every patient without discrimination. When the various investigators can present statistics with comparable numbers of patients and can show that their mortality rates are better than those from conservative methods, we will be the first to change our approach to the problem. But one must remember again that, only after the time span of a generation, will these advocates of methods other than conservative know what the final answer will be. ‘Today’, we choose to follow the conservative approach.

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© 1965 S. Karger AG, Basel
1965
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