Bladder Disorders

Abstract

Lower urinary tract (LUT) dysfunction is clinically relevant for three main reasons: (1) it may cause urinary tract infections (UTIs), mainly from the accumulation of residual urine; (2) it may adversely affect renal function from febrile UTIs or high intravesical pressure; and (3) it may cause incontinence and thus substantially lower the child’s quality of life. The function of the LUT is intimately associated with that of the bowel; constipation is both a common cause and consequence of many kinds of bladder dysfunction. Among the types of lower urinary tract dysfunction, detrusor overactivity is the main cause of daytime urinary incontinence in childhood. The condition is benign but socially harmful and needs to be differentiated from more serious conditions such as neurogenic bladder or urethral obstruction. The two cornerstones of treatment are urotherapy and eradication of concomitant constipation. Urotherapy includes instructing the child to keep a regular voiding and drinking schedule. If first-line therapy is unsuccessful, anticholinergic medication is often warranted. Another LUT disorder, voiding dysfunction, i.e., the habitual sphincter contraction during voiding, is common in children with detrusor overactivity. It may be selflimiting but may also result in residual urine and UTIs and can in severe cases be part of a syndrome indistinguishable from the neurogenic bladder and carry the same risks. A third disorder, neurogenic bladder dysfunction, most often caused by spinal dysraphism, is characterized by detrusor sphincter dyssynergia. This condition very often leads to recurrent UTIs and high intravesical pressures, threatening kidney function. The introduction of clean intermittent catheterization has improved the renal prognosis tremendously for the children affected by the disorder.