Abstract
ABSTRACTIntroduction:Defective closure of the neural tube affects different systems and generates sequelae, such as neurogenic bladder (NB). Myelomeningocele (MMC) represents the most frequent and most severe cause of NB in children. Damage of the renal parenchyma in children with NB acquired in postnatal stages is preventable given adequate evaluation, follow-up and proactive management. The aim of this document is to update issues on medical management of neurogenic bladder in children.Materials and Methods:Five Pediatric Urologists joined a group of experts and reviewed all important issues on “Spina Bifida, Neurogenic Bladder in Children” and elaborated a draft of the document. All the members of the group focused on the same system of classification of the levels of evidence (GRADE system) in order to assess the literature and the recommendations. During the year 2020 the panel of experts has met virtually to review, discuss and write a consensus document.Results and Discussion:The panel addressed recommendations on up to date choice of diagnosis evaluation and therapies. Clean intermittent catheterization (CIC) should be implemented during the first days of life, and antimuscarinic drugs should be indicated upon results of urodynamic studies. When the patient becomes refractory to first-line therapy, receptor-selective pharmacotherapy is available nowadays, which leads to a reduction in reconstructive procedures, such as augmentation cystoplasty.
Highlights
Defective closure of the neural tube affects different systems and generates sequelae, such as neurogenic bladder (NB)
There was controversy over which approach was better for the initial management of NB: proactive or expectant approach [4, 5], the balance seems to be in favor of the first, since with a proactive approach there is a reduction in chronic renal disease (CRD)
Hascoet et al performed a systematic review in children with neurogenic bladder and showed a wide range of results: continence could be achieved in 32% to 100%, maximum detrusor pressure decreased between 32% and 54%, maximum cystometric capacity increased between 27% and 162%, and compliance improved between 28% and 176%
Summary
Defective closure of the neural tube affects different systems and generates sequelae, such as neurogenic bladder (NB). Damage of the renal parenchyma in children with NB acquired in postnatal stages is preventable given adequate evaluation, follow-up and proactive management. The aim of this document is to update issues on medical management of neurogenic bladder in children. Materials and Methods: Five Pediatric Urologists joined a group of experts and reviewed all important issues on “Spina Bifida, Neurogenic Bladder in Children” and elaborated a draft of the document. During the year 2020 the panel of experts has met virtually to review, discuss and write a consensus document. Results and Discussion: The panel addressed recommendations on up to date choice of diagnosis evaluation and therapies. Submitted for publication: November 03, 2020 Accepted after revision: December 27, 2020 Published as Ahead of Print: February 28, 2021
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