Neurogenic bladder

Abstract

The chapter analyzes the most common neurological disorders, mainly myelodysplasia, which deal with neurogenic bladder dysfunction (NBD). The pathophysiology and the consequences on urinary continence and urological/renal function are described. Management of NBD in children has undergone major changes over the years. Reliable urodynamic investigation (UDS), the advent of clean intermittent catheterization (CIC), a plethora of drug therapies that modulate lower urinary tract function, a multitude of rehabilitative modalities, and advancement in surgical techniques had furnished the evidence-based ways and tools to manage neurogenic bladder in children. The steps of a clinical workup, both for those conditions starting at birth and the occult lesions detected later on, are underlined. The main goals of treatment remain the prevention of urinary tract deterioration and the achievement of continence. The newborn must be protected by those “at-risk” bladders, which can significantly alter renal function. While continence is usually addressed as the child reaches school age, issues such as elevated detrusor pressure, hydronephrosis and/or reflux, and chronic UTIs are treated at any time. Nowadays, the treatment of choice is initially conservative. Multiple conservative modalities, i.e., pharmacologic agents, medical devices, and neuromodulation, should be promoted before undertaking surgical interventions. Intermittent catheterization and drug therapy are usually sufficient for maintaining continence and preserving upper tracts. Surgical procedures should be considered if conservative measures fail to achieve continence between catheterizations or preserve upper tracts. The improvement of quality of life is the final goal. It is a difficult concept to measure because of lack of validated instruments and difficulties in translating from one culture or language to another.