Search

We have retrospectively investigated 71 patients with ICD-9 diagnoses 293.0 or 293.1, who were treated in our clinic in 1987, with respect to the maximum severity of altered consciousness. On the basis of an available neurological grading into "clouding of consciousness", "confusional state", "delirium", "stupor", and "coma", and from knowledge of the underlying somatic disease, we have developed prognostic criteria: Disorders of heart and circulation associated with acute organic mental disorder (with altered consciousness) carry a fair prognosis for recovery of the mental disorder in approximately two-thirds of all patients affected, even in advanced age. The same statement is valid with respect to drug-induced acute organic mental disorders, whereas most cases of cerebrovascular disorders with mental disturbances proceed to chronic forms of organic mental disorder. We believe that the clinical descriptive terms referred to above allow easy grading of states of acutely/subacutely altered consciousness, thereby providing prognostic criteria for the course of the disease.

The past 15 years have witnessed an explosion of new knowledge concerning the anatomy, neurophysiology, and pharmacology of the lower urinary tract. Knowledge of the localization of a neurologic lesion-suprapontine, suprasacral, cauda equina, or peripheral nerves-rather than the type of disease allows a more "rational approach" to the diagnosis and therapy of neurogenic voiding disorders. More specifically, advances in pharmacological understanding enable us, at least in theory, to treat voiding disorders according to their types of dysfunction: drugs to promote bladder emptying that exert their predominant effect on bladder and bladder outlet respectively, and those promoting bladder storage with the corresponding objectives. We discuss the problem that many theoretically sound drugs are, in fact, not clinically efficacious, probably due to incomplete understanding of the physiology of normal micturition and its neurogenic disorders.

Until recently, the management of impotence was mainly concerned with the distinction of psychogenic from organic causes of erectile failure. Patients with the former were offered psychosexual counselling, while surgery, principally in the form of prosthesis implantation, was reserved for those with organic impotence. With the identification of pharmacologic regimes that can successfully induce erection, it has become necessary to distinguish between vascular and neurogenic causes of erectile failure, since it is mainly the latter patient group that can profit from an intracavernosal injection therapy with papaverine and phentolamine. Neurogenic erectile failure is further classified according to lesion localization and underlying disease.