In order to re-educate the spinal cord bladder, it is important to realize which type the cord bladder belongs to, either automatic or autonomous.
The more correct information is obtained from cystometry, as a direct method, for differentiation between them.
Anal reflex, ice water test, and the testicles squeezing test were done as simple clinical tests, comparing with the results of cystometry.
Presence of anal reflex was well coincident with the automatic bladder, but there are some exceptional cases. Ice water test was not satisfactory for differentiation of bladder type, because the test was positive only in severe hypertonic bladder.
The testicles squeezing test was always negative in the complete paraplegic cases with the lesion over the lower third of Th. segment level.
However, the test was negative in many complete paraplegic cases with the lesion below L1 segment level.
So, further studies are required on it's clinical significance. It was observed by cystometry of automatic bladder that contraction of detrusor muscle (increase in pressure) was not developed by the trigger action for micturition, such as percussion, massage and so forth.
Therefore, it is speculated that the opening at the internal urethral orifice is primarily significant for micturition of paraplegia.
