Neurogenic Bladder

Abstract

Neurogenic bladder (NB) is a complex urological condition that requires an individualized approach tailored to the patient, best provided by a multidisciplinary team. NB can be divided in three groups: primary, secondary, and idiopathic. The large majority of NB in children is due to neural tube defects. The initial assessment of a child with NB begins with a detailed physical examination, a baseline renal profile, and a renal and bladder ultrasound. Video urodynamics (VUD), with or without electromyography, allows a detailed assessment of bladder function. Finally a dimercaptosuccinic acid (DMSA) scan is useful for the detection of renal scars. The medical management of a NB relies on a combination of regular clean intermittent catheterization (CIC), to allow regular emptying of the bladder, and bladder relaxant, usually anticholinergic/antimuscarinic and/or Β3 adrenergic receptor stimulant, to try to maintain low intravesical pressures. For children who fail conservative management, different surgical options are available to increase bladder capacity and to obtain a safe urinary storage, which include intravesical injection of botulinum toxin, urethral dilation, vesicostomy, detrusorotomy, and bladder augmentation. Different surgical procedures are also available to create a channel for CIC, formation of appendicovesicostomy (Mitrofanoff channel), and ileal conduit (Monti tube) or to increase bladder outlet resistance: bladder neck injections, suspension of the bladder neck (fascial sling), artificial urinary sphincters, and surgical reconstruction of the bladder neck. Neurogenic bladder and bowel are closely related; hence constipation in children with NB should be managed from an early age to promote cleanliness, to improve bladder dynamics, and to prevent urinary tract infections in a stepwise approach.