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November 3, 1956


JAMA. 1956;162(10):971-972. doi:10.1001/jama.1956.72970270002010a

Difficulty in urination is often the first clinical manifestation of a lesion of the sacral part of the spinal cord. No other obvious sign or symptom may be present, since the motor defect can be too low to involve movements of the lower extremities, and the sensory deficit, if present, is in the perineal region, an area where anesthesia is not discovered readily by the patient. Even a complete physical examination might not disclose the lesion, since one ordinarily does not test for sensory deficits in the saddle area. Since obstructive uropathy is the usual cause for a decrease in size and force of stream, the patient undoubtedly would be subjected to a urologic investigation. Endoscopy and cystometry might lead to a correct diagnosis if bladder sensation were absent. However, if sensation were intact and only the motor side involved, then the diagnosis might be missed and an unnecessary prostatectomy