Ischuria Paradoxa

ISCHURIA PARADOXA (from the Greek ischo- I hold back and ouron-urine), a term adopted to designate a peculiar symptom of urinary disturbance, characterized by the spontaneous excretion of urine drop by drop from a bladder filled to maximum capacity, with complete inability to voluntarily empty it. This symptom is observed in many diseases of the spinal cord, in tabes, in the initial stages of transverse lesions of the spinal cord of various etiologies (myelitis, compression); in the further course of the disease it gives way to a more normal, periodic emptying of the bladder, at which through prolonged intervals of time (1-2 hours) significant portions of urine are expelled, indicating the isolation of the spinal center of urination from the cerebral cortex, as a result of which the bladder's activity becomes automatic; however, emptying of the bladder in this case is not complete, as the expelled portions are smaller than normal. Elimination of I. paradoxa is achieved by treating the primary affection of the spinal cord.

A. Surov. I. p. is also observed in some urological diseases. In the so-called hypertrophy of the prostate (in the third stage) B.M.E.T.Kh. I. p. is the main symptom of this stage of the lesion. In addition, I. p. is observed in long-existing, pronounced stricture of the urethra, which hinders emptying of the urinary bladder, causing the bladder muscle to first hypertrophy, and then stretch and lose normal tone. In the preceding stages of prostatic hypertrophy and urethral stricture before the onset of the symptom I. p., there is always chronic retention of urine (residual urine) with the presence of frequent voluntary urination. Later, when the reserve forces of the muscular apparatus of the urinary bladder are exhausted, complete atony of not only the detrusor but also the sphincter occurs, and thus the coordination between both muscular apparatuses of the urinary bladder, normally acting as antagonists, is disrupted. In I. p. the detrusor and sphinctor are simultaneously in a state of relaxation, which explains the constant incontinence of urine despite the inability to empty the overfilled bladder. I. p., caused by urethral stricture, is usually eliminated after removal of the obstacle by systematic dilation of the canal or - even better - by internal urethrotomy. The urinary bladder after the performed operation begins to empty on its own due to restoration of the contractile ability of the detrusor. I. p. in prostatic hypertrophy can be eliminated as a result of removal of the primary cause of the disease, i.e., adenoma of the prostate gland. However, this is possible only in a minority of cases. Usually, I. p. in prostatic hypertrophy occurs when there is already such significant stretching of the upper urinary tracts with subsequent atrophy of the renal parenchyma that the operation is meaningless due to insufficient kidney function. Therefore, all methods of functional diagnosis of the kidneys should be applied to such patients, and on the basis of this study the question of radical or conservative treatment methods should be decided. In prostatic hypertrophy in cases where there are contraindications to removal of the prostate gland, partial elimination of I. p. can be achieved by systematic catheterization (3-4 times a day) or by using a permanent catheter. Catheterization, especially initially, should be performed carefully, and the bladder should be emptied gradually, not in one session, to avoid bleeding ex vacuo. Catheterization should be performed with careful observance of asepsis, as the atonic bladder is extremely easily infected. This is especially important in I. p. with clear urine. Simultaneously with catheterization, disinfectants are prescribed orally or intravenously. To avoid irritation of the skin by constantly excreted urine and to eliminate odor, wearing a rubber urine collector is recommended. Ya. Gottlieb.

Q.S., a term used in prescriptions, abbreviation for quantum satis or quantitas sufficiens; means: in sufficient quantity, as much as is needed, as much as is required.