SUMMARY A case of herpes zoster is described in which the third and fourth sacral segments were involved on the left side, and in which an eruption on the left side of the bladder was accompained by retention of urine. Thirteen other case reports have been reviewed in which bladder symptoms complicated sacral zoster. There appears to be an inverse relation between the severity of the bladder eruption and the incidence of retention of urine, and this may be explicable on the basis of variable spread of the virus within the nervous system.

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Fifty-two male patients were studied prospectively to assess the results of direct vision urethrotomy in the treatment of urethral strictures. The prognosis was found to be significantly worse in those patients who had received extensive previous treatment. A catheter is recommended for at least 3 days and for 4 weeks in patients who have had minimal previous treatment or who have impaired detrusor function. The use of a urine flowmeter is essential for determining the success of treatment and stricture recurrence. Measurement of the recurrence-free period is important for assessing progressive improvement following repeat urethrotomy and for determining which patients cannot be cured by direct vision urethrotomy.

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Urethral pressure profiles were recorded in a series of patients with traumatic lesions of the spinal cord producing vesico-urethral dysfunction. Patients were classified into groups depending upon the relationship of the lesion to the sympathetic outflow to the bladder and urethra from the spinal cord. Using alpha-adrenergic blocking agents, the smooth muscle contribution to the maximum urethral pressure was ascertained in each group and differences in both the configuration of the profile, and the smooth muscle component, were found. Increases in the maximum urethral pressure in response to a change in posture were also investigated, and the extent of the increase found to vary according to the level of the spinal lesion in respect of the sympathetic outflow, and with the integrity of the sacral cholinergic reflex arcs. The hypothesis that these changes may be due to urethral "decentralisation supersensitivity" from alterations in circulating catecholamine levels is suggested.

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Summary Division of the external sphincter may be required for obstruction at that level with or without evidence of spasticity. In supra‐sacral lesions with good detrusor contractions there is normally no indication for a bladder neck resection and, when necessary, external sphincterotomy can confidently be carried out as a primary procedure. In sacral lesions, bladder neck resection may be required as a substitute for the normal opening mechanism, and this may have to be followed by division of an obstructive but non‐spastic external sphincter region. The operation shows up favourably as regards simplicity, safety, effectiveness and freedom from complications when compared with the alternative procedures which have been suggested.