Nonneurogenic Neurogenic Bladder Dysfunction Diagnosed Prenatally Or In Early Infancy

Abstract

PURPOSE Nonneurogenic neurogenic bladder (NNNB) is a potentially severe dysfunctional voiding disorder including detrusor-sphincter functional dyssynergia and upper-tract dilatation without anatomic outlet obstruction or neurological defect. Although NNNB is thought to be an acquired condition it seems that it can sometimes be a congenital dysfunction, revealed before toilet training. We report our experience with NNNB diagnosed during early infancy, focusing on those revealing on prenatal US. MATERIAL AND METHODS We retrospectively reviewed the cases of NNNB in children diagnosed before toilet training. We included either cases of NNNB dysfunction without prenatal symptoms (group 1) and children with urinary tract abnormalities on prenatal ultrasound (group 2). RESULTS In group 1, six children (two females) presented at a median age of 20 months (range 2- 30) with indirect signs of bladder dysfunction including either vesico-ureteral reflux (n = 4) and/or hydro-ureteronephrosis (n = 4). After a median follow-up of 11 years (range 5–20), 3/6 children were on clean intermittent catheterization (two Mitrofanoff), and 3/6 underwent bladder augmentation . Three children had chronic renal failure of whom one underwent renal transplant. In group 2, five children (one girl, T21) had prenatally diagnosed bilateral hydro-ureteronephrosis. Follow-up showed decompensation toward severe bladder dysfunction, diagnosed either after toilet training, or after ureteral reimplantation (n = 3). Currently, with a median follow-up of 14 years (range 0,5-20), 4/5 were on CIC with bladder augmentation, and the remaining required sphincterial reeducation with good result. Two of them had chronic renal failure. CONCLUSIONS All of these cases NNNB were initially misdiagnosed. In both groups, follow-up revealed upper tract severe impairment and secondary renal dysfunction. Antenatal diagnosis of bilateral pyeloureteral dilatation may be the first sign of early bladder dysfunction.