Neurogenic Bladder Dysfunction In Children Research Articles

Intravesical Botulin Toxin-A Injections for Neurogenic Bladder Dysfunction in Children: Summary Update on Last 10 Years of Research

Intravesical Botulin Toxin-A Injections for Neurogenic Bladder Dysfunction in Children: Summary Update on Last 10 Years of Research

Analysis of complications of neurogenic bladder dysfunction in children

Dysfunction of the lower urinary tract is a fairly common consequence of perinatal lesions of the nervous system. Dysfunction of the bladder and muscles of the urogenital diaphragm in this group of children can be accompanied by severe urodynamic disorders and, in some cases, can lead to complications such as chronic recurrent urinary tract infection, vesicoureteral reflux, nephrosclerosis, kidney atrophy, chronic renal failure. Purpose. To study uronephrological complications in children with various forms of neurogenic bladder dysfunction and suggest methods for their prevention and pathogenetic treatment. Material and methods. 67 children with neurogenic bladder dysfunction were examined. All children underwent comprehensive uronephrological and neurological diagnostics using objective neuroimaging, electrophysiological and functional research methods. Results. Complications leading to somatic health disorders in patients were diagnosed. These included chronic cystitis — in 13 (19.4%) patients, chronic pyelonephritis — in 57 (85.1%), vesicoureteral reflux — in 25 (37.3%), chronic renal failure — in 8 (11.9%) children. Therapy for neurogenic bladder dysfunction consisted of basic therapy of the central nervous system lesion, as well as symptomatic therapy aimed at normalizing the functional state of the bladder. In the vast majority of cases of neurogenic bladder dysfunction complications, their relief occurred within a year in the process of curing the underlying disease. In some cases, in children with severe neurological disorders (myelodysplasia, meningoradiculocele), along with medication and physiotherapy, surgical manipulations (periodic bladder catheterization) and surgical interventions (epicystostomy) were performed. Conclusion. In children with detrusor hyperreflexia and mild «high» lesions of the nervous system, clinical symptoms of neurogenic bladder dysfunction were usually noted, worsening only their quality of life. In children with a significant neurological deficit and a rather severe lesion of the lumbosacral spinal cord, complications developed that worsened the somatic health of this group of patients.

Effect of bladder volume and compliance on ultrasonographic measurement of bladder wall thickness in children with neurogenic bladder dysfunction

Spina bifida is the most common cause of neurogenic bladder dysfunction in children. Measurement of bladder wall thickness (BWT) is non-invasive, low-cost, and may be complementary to urodynamics in demonstrating bladder condition. It is still unknown the wall thickness response to volume change in bladders with different compliance states. To determine the most appropriate measurement technique by revealing the differences in measurements performed in different compliance and volume conditions in children with neurogenic bladder. In the prospective study in 2022, patients with spina bifida who continued their urological follow-up in our spina bifida center were included. Patients with a diagnosis of the neurogenic bladder who performed clean intermittent catheterization at least 4-6 times a day and had a recent urodynamic result in the last 6 months were included in the study. According to urodynamic results, patients were divided into two groups normocompliant (NC) and low-compliant (LC) bladders. BWT measurements were made from the anterior, posterior, right lateral, and left lateral walls of the bladder 3 times as full, half-volume, and an empty bladder. The study included 50 patients (NC group n:21, LC group n:29). The mean age of 24 female and 26 male patients was 6.45±4.07 years. In all BWT measurements, a significant increase in wall thickness was observed with decreasing bladder volume. The best correlation between bladder volume and BWT was found in the anterior wall with a weak negative correlation (p=0.049, r=-0.280). However, lateral wall measurements were significantly higher in low compliant patients compared to normocompliant patients when the bladder was full. The mean right lateral wall thickness was 1.58±0.68mm in the NC group and 2.18±1.35mm in the LC group (p=0.044). Left lateral wall thickness was 1.45±0.44mm in the NC group and 2.02±1.4mm in the LC group (p=0.033). Although standardization has been tried to be achieved in BWT measurements, we understand from the studies in the literature that there is no unity in practice. Lateral wall measurements were found to be significantly higher in LC patients compared to normocompliants in full bladder suggesting that more accurate BWT follow-up can be performed with lateral wall measurements in neurogenic bladder patients if bladder compliance is low. The present study seems to be the first study in the literature in which bladder compliance and ultrasonographic bladder wall thickness measurements were evaluated together in children with neurogenic bladder dysfunction.

Approach to the choice of methods for correction of neurogenic bladder dysfunction in children

Currently, parents of various specialties are turning to doctors with complaints of urination disorders in children, which is manifested by urinary incontinence during the daytime, imperative urges and enuresis. These disorders are associated with functional disorders, if there are no malformations of the spinal cord resulting from the immaturity of the growing organism or may be the cause of the detrimental effect of the benefits of civilization on the emerging organism. The function of the lower urinary tract consists of the friendly but opposite activity of the detrusor and sphincter. We have a wide range of medicines, treatment methods, biofeedback and physiotherapy, but the so-called golden standard of treatment does not yet exist. Each of these methods should be prescribed according to clearly identified diagnostic criteria.

PD02-05 EFFICACY AND SAFETY OF VIBEGRON AS ADJUVANT TREATMENT ON REFRACTORY NEUROGENIC BLADDER DYSFUNCTION IN CHILDREN WITH SPINA BIFIDA

You have accessJournal of UrologyCME1 May 2022PD02-05 EFFICACY AND SAFETY OF VIBEGRON AS ADJUVANT TREATMENT ON REFRACTORY NEUROGENIC BLADDER DYSFUNCTION IN CHILDREN WITH SPINA BIFIDA Kazuyuki Nishinaka, and Naoya Masumori Kazuyuki NishinakaKazuyuki Nishinaka More articles by this author , and Naoya MasumoriNaoya Masumori More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002517.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The aim of this study was to evaluate the efficacy and safety of vibegron with improved selectivity and metabolic stability in comparison with previously disclosed β3-adrenoceptor agonists for treating antimuscarinic-resistant neurogenic bladder dysfunction in children with spina bifida. METHODS: In this retrospective study, 19 patients below 15 years of age, with antimuscarinic-resistant neurogenic bladder dysfunction due to spina bifida, underwent a video-urodynamic study before and during the prescription of vibegron. The dosage was 12.5, 25 or 50 mg once daily, based on age and body weight, for at least 12 weeks from January 2020 to July 2021, in addition to antimuscarinic therapy. The video-urodynamic study was conducted to evaluate bladder compliance, maximum cystometric bladder capacity, detrusor overactivity, detrusor leak point pressure, and vesicoureteral reflux. This was done subsequently prior to the beginning and after three months of vibegron administration. Patient-reported efficacy and adverse events were measured. RESULTS: Treatment with vibegron add-on therapy drastically improved bladder compliance and maximum cystometric bladder capacity compared to treatment with antimuscarinic agents alone (6.2; IQR: 5.2–10.4 vs. 28.3; IQR: 22.7–50.7 mL/cmH2O, P < 0.0001; and 178; IQR: 135–235 vs. 450; IQR: 358–502 mL, P<0.0001, respectively). Bladder deformity in 12 patients improved after taking the drug (image 1: before taking vibegron and image 2: after taking vibegron, obtained from the same case). Moreover, vesicoureteral reflux, confirmed in four patients, disappeared post administration. All the 18 patients who were incontinent before remained dry after initiating therapy with vibegron during the daytime. None of the patients showed side effects or discontinued treatment owing to intolerance to vibegron. CONCLUSIONS: Vibegron as adjuvant treatment in children with antimuscarinic-resistant neurogenic bladder dysfunction due to spina bifida showed favorable video-urodynamic efficacy with no apparent adverse events. Vibegron helped to achieve urinary continence in the entire sample population. Vibegron is a favorable treatment option for the treatment of refractory neurogenic bladder dysfunction in children with spina bifida. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e37 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kazuyuki Nishinaka More articles by this author Naoya Masumori More articles by this author Expand All Advertisement PDF DownloadLoading ...

Treatment of various forms of neurogenic bladder dysfunction in children

Treatment of various forms of neurogenic bladder dysfunction in children

Onabotulinumtoxin A (Botox): A reasonable alternative for refractory neurogenic bladder dysfunction in children and young adults.

We aimed to describe the effectiveness of Onabotulinumtoxin A (Botox) in children with neurogenic bladder (NGB) unresponsive to medical therapy to determine urodynamic parameters predictive of success. Children receiving Botox for refractory NGB, between 2008 and 2019, from a single academic center, were included in this study. Botox success was defined as improvement of incontinence and/or urodynamic parameters. Of 34 patients who received Botox, 13 (38.2%) had a positive response from their first injection, with improvement in capacity by a median of 35% of expected capacity for age compared to only a 9% increase in those who did not respond clinically. When patients were divided into groups by baseline urodynamic parameters, high-pressure (Pdetmax > 20 cm H2 O) patients had significantly greater improvement in compliance compared with low-pressure patients (p = 0.017). Low compliance patients (<10 ml/cm H2 O) had a dramatic improvement of 3.08 ml/cm H2 O in their compliance compared with minimal change in the high compliance group (p = 0.003). Finally, low-capacity (<50% of expected CC) patients had significant improvement in capacity and compliance when compared with high-capacity patients (p = 0.004 and p = 0.036, respectively). Improvement in detrusor overactivity (DO) was noted in both the clinical responders and non-responders. In our series, 38% had clinical success with intradetrusor Botox injections for refractory neurogenic bladder. When successful, improvement in capacity and compliance, DO, and/or incontinence was consistent with prior literature. While we could not determine which parameters predicted success, subdividing patients into categories based on baseline urodynamic parameters identified who would benefit from Botox treatment based on differential improvements in capacity and compliance. At least 1 injection of Botox should be considered for a subset of children with refractory NGB, before undertaking more invasive treatments.

NEUROGENIC BLADDER DYSFUNCTION IN CHILDREN PROGRESS TO KIDNEY FAILURE IN ADOLESCENCE AND YOUNG AGE: PERSONALISED MENAGEMENT, REVIEW AND CASE SERIES

Newborn infants who had neurogenic bladder dysfunction (NBD) have a normal upper urinary tract.Most of them will develop deterioration of renal function, and chronic kidney disease in case they donot received proper management. Renal damage is due to high detrusor pressures resulted from poorcompliance of the bladder, beside detrusor over-activity against a closed sphincter or detrusor sphincterdyssynergia.To preserve renal function and prevent deterioration of the kidneys, NBD must be treated immediatelyafter being diagnosed. Over the last few years there was great progress in the treatment of childrenwith the NBD. Neurogenic bladder dysfunction in children must be diagnosed early in life and thechild should receive the proper management, neglecting the case or improper management would endwith deleterious effect on the upper tract end with renal dysfunction and chronic kidney failure. Thereare different options for management. The type of management would be personalized for each caseand could be modified. Case series were presented to illuminate the early management value of childrenwith NBD in situation of unavailable of advanced methods of treatment.The different approaches for management including the recent approaches were reviewed. This caseseries elaborate the management of 24 Egyptian children with NBD and impairment of renal function.The children underwent cutaneous vesicostomy at early stages of the disease. The procedure was feasibleand protected the kidney from deterioration tell adolescence. This procedure is feasible in limitedhospital resources and/or low-middle income countries.

The application of laser radiation and thermotherapy for neurogenic bladder dysfunction in children (methodological recommendations)

The methodological recommendations are devoted to the application of low-energy laser irradiation (LELI) and thermotherapy for neurogenic bladder dysfunction in children (NBD). As a result of the studies, the high therapeutic efficiency of the combined use of low-energy laser irradiation and thermotherapy for neurogenic bladder dysfunction in children has been proven. For the first time, the scientific substantiation of the complex application of such methods of physiotherapy as laser therapy and thermotherapy for neurogenic dysfunction of the bladder in children is given; the therapeutic effectiveness of these physical factors in the complex treatment of NBD in children is studied. The influence of laser therapy and thermotherapy on the clinical course of NBD in children, the state of urodynamics, and the speed characteristics of the act of urination were revealed. The optimal parameters of the exposure, differentiated indications and contraindications to the method have been developed. The methodological recommendations are intended for physiotherapists, pediatricians, urologists, nephrologists of children’s medical and preventive institutions (hospital, polyclinic, rehabilitation center, health resort institutions).

Urodynamic Study Findings Prior to Myelomeningocele Repair in Neonates.

ABSTRACTIntroduction:Myelomeningocele (MMC) is the most common cause of neurogenic bladder dysfunction in children. Neurogenic bladder dysfunction is developed before birth due to autonomous nervous system affected prenatally in patients with MMC. The aim of this study was to share urodynamic study findings before MMC repair and to discuss the correlation with neurological evaluation.Materials and Methods:We prospectively studied 37 patients who underwent surgery for MMC repair in our institution in the first 20 h of their lives between 2013 and 2016. All patients were evaluated by a neurosurgeon, neonatologist, and pediatric surgeon. Urodynamic study was performed in first 18h of life before MMC repair in all patients. Lesion level, occurrence of hydrocephalus, neurological functions, spinal deformities, and urodynamic study results were analyzed.Results:The study included 18 female and 19 male patients. Overactive detrusor was detected in 22 patients, and hypoactive detrusor was detected in 5 patients. Overactive sphincter muscle was detected in 32 patients, and hypoactive sphincter was detected in 2 patients. Detrusor–sphincter dyssynergia was present in 34 patients.Conclusion:Detailed analysis of urodynamic study findings in larger patient groups may be important to understand the physiopathology of prenatal damage in patients with MMC.

Neurogenic bladder dysfunction in children.

Neurogenic bladder dysfunction is the cause of a small proportion of urinary problems in children. Various neurological conditions can result in a change in neural control of the bladder, and also the colon. Some of these conditions are apparent at birth; others are discovered later, and it is important that the primary health service be aware of them, so that targeted treatment can be provided.

Distribution of interstitial cells of Cajal in the bladders of fetal rats with retinoic acid induced myelomeningocele.

Myelomeningocele (MMC) is one of the most common reason of neurogenic bladder dysfunction in children. Although neurogenic bladder dysfunction occurrence is related with bladder innervation, also there are some changes seen in the smooth muscle and neural cells of the bladder. Interstitial cells of Cajal (ICC) are the pacemaker cells found in organs with peristaltic activity. Although it has been shown that ICC are diminished in the rat urinary bladder with traumatic spinal cord injury, there is no data about ICC in fetal rat bladders with MMC. This study has been conducted to investigate the ICC in the bladders of fetal rats with retinoic acid induced MMC. Time dated pregnant Wistar albino rats were divided into 3 groups. In MMC group, dams were fed with gavage solution containing 60 mg/kg all-trans retinoic acid dissolved in olive oil on 10. embryologic day. Sham group animals were fed only olive oil. Control group dams were fed with standard rat chow. Fetuses were delivered by cesarean section and harvested on 22. embryologic day. MMC was identified by observing MMC sacs at the back of the fetuses. Distribution of ICCs were evaluated using immunohistochemical staining. ICCs were found in all groups, which have the same morphological features that had been described earlier in the gastrointestinal tract and the bladder. The density of the ICC in the MMC group was found to be significantly decreased when compared with the control and the sham groups (p<0.05). The density of the ICC in the urinary bladder decreased in the neurogenic bladder developed in MMC.

Sacral Nerve Stimulator Revision Due to Somatic Growth

Sacral nerve modulation is a Food and Drug Administration approved treatment for refractory urgency, frequency, urge incontinence and nonobstructive urinary retention in adults. The sparse literature on sacral nerve modulation in children focuses on its initial efficacy in patients with neurogenic bladder and dysfunctional elimination. We describe our initial experience with sacral nerve modulation and the phenomenon of growth spurts associated with lead malfunction that necessitates revision. After receiving institutional review board approval we retrospectively reviewed the charts of pediatric patients who underwent sacral nerve modulation surgery at our institution. Charts were examined for patient demographics, subjective success, the need for further surgery and success after revision. Four patients underwent sacral nerve modulation at an average age of 12.1 years. All patients reported initial success, defined as greater than 50% symptom improvement. Subsequently 3 patients required a total of 5 revisions due to lead malfunction with an average of 1.5 years between surgeries. In those requiring revision the average somatic growth between revisions was 8.1 cm. Return of efficacy was reported after each revision. All patients had functioning nerve stimulators in place and continued to have a positive subjective response. The sparse data on sacral nerve modulation in children shows efficacy and safety similar to those in adults. Somatic growth may be associated with lead malfunction and require surgical revision. We report a small series showing that revision can be done successfully and safely. Informed consent for sacral nerve modulation in pediatric patients should include a discussion of somatic growth as a possible cause of lead malfunction necessitating revision.

Sacral Neuromodulation in Children With Urinary and Fecal Incontinence: A Multicenter, Open Label, Randomized, Crossover Study

The clinical benefit of sacral neuromodulation is unclear due to the paucity of randomized trial data. The purpose of this study was to evaluate sacral neuromodulation for management of urinary and fecal incontinence in a pediatric population. This multicenter, open label, randomized, crossover study included children older than 5 years. After trial stimulation of the S3 root a neuromodulator (InterStim) was implanted on the S3 foramen. Clinical examinations, voiding and bowel diaries, and urodynamic and manometric evaluations were performed at the beginning (t1) and end (t2) of the first period, and at the beginning (t3) and end (t4) of the second period. A total of 33 patients (24 boys) with a mean +/- SD age of 12.22 +/- 5.09 years were randomized. Etiologies were mainly of neurological origin. Incontinence was mixed urinary and fecal in 19 cases, urinary only in 9 and fecal only in 5. Cystometric bladder capacity increased during sacral neuromodulation (delta +24.27 ml vs -37.45 ml, p = 0.01). There was no significant change in other urodynamic or manometric parameters. Overall positive response rate was more than 75% for urinary (81%) and bowel (78%) function. Crossover analysis indicated that sacral neuromodulation is more effective than conservative treatment for both types of incontinence (p = 0.001). In a pediatric population sacral neuromodulation is effective for bladder and bowel dysfunction and should be considered before irreversible surgery.

A Mini-Invasive Approach to Severe Neurogenic Bladder as an Alternative to Diversion and Augmentation with Reimplantation in Selected Children

Purpose In the past years we demonstrated as combined endoscopic injection of botulinum toxin type A (BTXA) and dextranomer/hyaluronic acid (DHA) could be effective in the management of vesicoureteral reflux (VUR) in neurogenic bladder dysfunction (NBD) not responding to clean intermittent catheterization (CIC) and anticholinergics. When patients or caregivers are unable to catheterize native urethra other options must be considered. We present our preliminary experience in the treatment of VUR and NBD in children, unabled to perform CIC, using a new combined mini-invasive approach. Material and Methods 3 patients with NBD and VUR enabled to perform CIC, aged from 5 to13 yrs (mean 8.5) were treated, after ethical and scientific committee approval, and written consent obtained. All patients presented severe urinary tract infections (UTI) and VUR was present in all renal units. VUR and NBD were evaluated with videourodynamics, pre and post-op. First suburetheral injection of DHA (0.5-1 ml/side) and bladder BTXA injections (10 IU/Kg, max 300 IU) were performed and then percutaneous cistostomy (Mic-Key gastrostomy) button was inserted according to original Subramaniam's technique, under endoscopic control. Results The mean operative time was 40 minutes.No complications were reported either intraoperative either at the follow-up (mean 5.5 months).UTI was solved in all, as well as VUR, but in one unit, where VUR decreased only (5° to 3°).All buttons are functioning and in situ. Buttons were changed every 3 months,and bladder drainage was found easy to perform in all.Urodynamics data (capacity, leak point pressure)improved in all. Conclusions Today the management of NBD is mainly conservative, but in selected cases surgery is required. However surgical procedure is not always related to an improvement of quality of life. For this reason button cistostomy endoscopic insertion associated to endoscopic treatment of VUR and NBD could be a valid alternative to derivation, augmentation and reimplantation in the short and medium- term period, in selected children.

Impact of spinal cord malformation on bladder function in children with anorectal malformations

Purpose Risk factors for the presence of neurogenic bladder dysfunction (NBD) in children born with high anorectal malformations (ARMs), were investigated, to identify the need for urodynamics in these patients. Material and Methods The study included 37 patients with high ARMs (21 boys and 16 girls). Bladder function was evaluated with urodynamics both before and after anorectoplasty (posterior sagittal anorectoplasty [PSARP]). All patients were investigated with spinal radiograph. Spinal ultrasound was performed in the neonatal period, and magnetic resonance imaging was added in case of abnormal ultrasound or urodynamics and in case of cloacal malformation. Results In ARM patients with rectourethral and vestibular fistulas and cloacas, NBD was identified in 9 children (25%). The bladder dysfunction was innate in all cases except in one girl with cloaca, indicating that the risk of iatrogenic denervation seems minimal using the PSARP technique. All children with innate NBD had a spinal cord malformation either as spinal cord regression or tethering with or without a lipoma. Concerning vertebral status, almost all children with NBD had partial sacral agenesis. Abnormal perineal appearance was highly correlated to NBD in boys, especially in those with a spinal cord regression malformation. Innate NBD was not found in any child with normal spinal cord. Conclusion From these results, we suggest that spinal ultrasound and perineal inspection are used as screening procedures for NBD in children with ARM. Urodynamic investigation is recommended only when spinal cord anomalies or other signs indicative of NBD are present. In case of spinal cord malformation, repeated urodynamics during follow-up is mandatory because of the risk for developing tethered cord syndrome.

Electrical stimulation in the treatment of neurogenic bladder dysfunction

Voiding and storage of urine are performed by the urinary bladder and the urethra, which are neurally controlled by the sacral nerves. Neurologic disturbances can influence switching between storage and voiding that results in voiding dysfunction, leading to neurogenic bladder. Causes of neurogenic bladder dysfunction include spinal cord injury or trauma; central nervous system tumors; demyelinating disease involving the spinal cord; spinal cord ischemia; cerebral palsy; and myelomeningocele, which is the most common cause of neurogenic bladder dysfunction in children. This article provides information about neurogenic bladder dysfunction and the current treatment options using electrical neuromodulation, comparing the various available modalities.

Sacral Neuromodulation for the Dysfunctional Elimination Syndrome: A Single Center Experience With 20 Children

Recent advances in neuromodulation have demonstrated promise in treating children with the dysfunctional elimination syndrome refractory to medical management. Sacral nerve stimulation with the InterStim implantable device has been used in adults for management of chronic urinary complaints. However, there are few data regarding the usefulness of sacral nerve stimulation in children. We report our experience with sacral nerve stimulation for severe dysfunctional elimination syndrome. A total of 20 patients 8 to 17 years old with the dysfunctional elimination syndrome refractory to maximum medical treatment underwent sacral nerve stimulation at our institution. Patients were followed prospectively for a median of 27 months after the procedure. Urinary incontinence, urgency and frequency, nocturnal enuresis and constipation were improved or resolved in 88% (14 of 16), 69% (9 of 13), 89% (8 of 9), 69% (11 of 16) and 71% (12 of 17) of the patients, respectively. Urinary retention requiring intermittent catheterization persisted in 75% of the patients (3 of 4) despite sacral nerve stimulation. Complications requiring operative treatment occurred in 20% of the patients (4 of 20). Following marked symptomatic improvement 2 devices were explanted at 20 and 19 months following placement, and both patients have remained symptom-free. Sacral nerve stimulation is effective in the majority of our patients, and should be considered in children with severe dysfunctional elimination syndrome refractory to maximum medical treatment.

The neurogenic bladder: introducing four contributions

Neurogenic bladder dysfunction in children is frequently seen in patients with meningomyelocele (MMC). The disorder carries a high risk for all kinds of complications, with renal damage being the most important. More than 95% of MMC patients have a neurogenic bladder, the paramount manifestation of which is a disturbed coordination between detrusor and sphincter muscles. This vesicourethral dysfunction leads to defective filling and emptying of the urinary bladder. Voiding at will is almost never possible. According to the location and extent of the neural tube lesion, patients have either an atonic or a hypertonic pelvic floor and either an atonic or a hypertonic detrusor, leading to four classic combinations. Hypertonic sphincter and detrusor hyperactivity lead to the most dangerous form of neurogenic bladder, referred to as the "unsafe" bladder. The presence of residual urine in a high-pressure container causes either decompensation of the detrusor with vesicoureteral reflux or deterioration of the bladder wall with hypertrophy and stiffness resulting in uterovesical obstruction. The subsequent insufficient drainage of the upper urinary tract leads to decompensation of the ureters and finally to chronic renal disease, the process being accelerated by urinary tract infections. The aim of treatment is to restore as much as possible both essential functions: urine storage and timely emptying of the reservoir. What should and can be achieved is a more or less adequate, low-pressure, functional capacity of the bladder that is emptied as completely as possible by clean intermittent catheterization (CIC). MMC leads to the prototype of neurogenic bladder in childhood. What we know and what we do for MMC patients can roughly be applied to all other forms of neurogenic bladder, either congenital or acquired.

Neurogenic bladder dysfunction in children

Neurogenic bladder dysfunction in children