Skip to main content

Advertisement

SpringerLink
Log in

Contemporary Management of Neurogenic Bladder in Children

  • Urology (P Reddy and B Vanderbrink, Section Editors)
  • Published:
Current Treatment Options in Pediatrics Aims and scope Submit manuscript

Abstract

Purpose of review

The management of neurogenic bladder (NGB) is an evolving task that derives its principles from the long-term goals of renal protection and optimization of quality of life. This review describes contemporary diagnostic techniques as well as expanding treatment options.

Recent findings

Innovation within the field has chiefly been in the form of new modalities for maintaining low bladder pressures and developing minimally invasive approaches to surgical reconstruction. A new and quickly expanding area of interest is “transitional care” (also known as congenitalism) for the aging pediatric patient with NGB with a particular emphasis on establishing adequate adult care for medical and urologic needs.

Summary

Adhering to timeless principles while innovating in the field to maximize quality of care is critical to continue to provide the best care for NGB patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Figure 1

Similar content being viewed by others

References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Sawin KJ, et al. The National Spina Bifida Patient Registry: profile of a large cohort of participants from the first 10 clinics. J Pediatr. 2015;166(2):444–50. e1

    Article  PubMed  Google Scholar 

  2. Berry JG, et al. Health inequity in children and youth with chronic health conditions. Pediatrics. 2010;126(Suppl 3):S111–9.

    Article  PubMed  Google Scholar 

  3. Atta CA, et al. Global birth prevalence of spina bifida by folic acid fortification status: a systematic review and meta-analysis. Am J Public Health. 2016;106(1):e24–34.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Chan YY, Sandlin SK, Kurzrock EA. Urological outcomes of myelomeningocele and lipomeningocele. Curr Urol Rep. 2017;18(5):35.

    Article  PubMed  Google Scholar 

  5. Lloyd JC, et al. Contemporary epidemiological trends in complex congenital genitourinary anomalies. J Urol. 2013;190(4 Suppl):1590–5.

    Article  PubMed  Google Scholar 

  6. Hopps CV, Kropp KA. Preservation of renal function in children with myelomeningocele managed with basic newborn evaluation and close followup. J Urol. 2003;169(1):305–8.

    Article  PubMed  Google Scholar 

  7. Adzick NS. Fetal surgery for myelomeningocele: trials and tribulations. Isabella Forshall Lecture. J Pediatr Surg. 2012;47(2):273–81.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Clayton DB, et al. Long-term urological impact of fetal myelomeningocele closure. J Urol. 2011;186(4 Suppl):1581–5.

    Article  PubMed  Google Scholar 

  9. Lee NG, et al. In utero closure of myelomeningocele does not improve lower urinary tract function. J Urol. 2012;188(4 Suppl):1567–71.

    Article  PubMed  Google Scholar 

  10. Dudley AG, et al. Interrater reliability in pediatric urodynamic tracings: a pilot study. J Urol. 2017;197(3 Pt 2):865–70.

    Article  PubMed  Google Scholar 

  11. Cameron AP, et al. Best practice policy statement on urodynamic antibiotic prophylaxis in the non-index patient. Neurourol Urodyn. 2017;36(4):915–26.

    Article  CAS  PubMed  Google Scholar 

  12. Snow-Lisy DC, et al. Reassessing the utility of routine urine culture with urodynamics: UTI incidence and risk factors. J Pediatr Urol. 2017;13(4):372 e1–8.

    Article  Google Scholar 

  13. • Ouyang L, et al. Characteristics and survival of patients with end stage renal disease and spina bifida in the United States renal data system. J Urol. 2015;193(2):558–64. This matched cohort study used the US Renal Data System to compare SB patients who developed ESRD to the rest of the population over a four year period. SB patients were younger (41 vs. 62 years) and less likely to undergo renal transplantation however mortality overall was not affected. This underscores the importance of contemporary management continuing to focus on renal protection.

    Article  PubMed  Google Scholar 

  14. Kaefer M, et al. Improved bladder function after prophylactic treatment of the high risk neurogenic bladder in newborns with myelomentingocele. J Urol. 1999;162(3 Pt 2):1068–71.

    Article  CAS  PubMed  Google Scholar 

  15. Dik P, et al. Early start to therapy preserves kidney function in spina bifida patients. Eur Urol. 2006;49(5):908–13.

    Article  PubMed  Google Scholar 

  16. Koh CJ, et al. Bladder and external urethral sphincter function after prenatal closure of myelomeningocele. J Urol. 2006;176(5):2232–6.

    Article  PubMed  Google Scholar 

  17. Chaudhry R, et al. Risk factors associated with recurrent urinary tract infection in neurogenic bladders managed by clean intermittent catheterization. Urology. 2017;102:213–8.

    Article  PubMed  Google Scholar 

  18. Kaye IY, Payan M, Vemulakonda VM. Association between clean intermittent catheterization and urinary tract infection in infants and toddlers with spina bifida. J Pediatr Urol. 2016;12(5):284 e1–6.

    Article  Google Scholar 

  19. Nguyen MT, et al. Overnight catheter drainage in children with poorly compliant bladders improves post-obstructive diuresis and urinary incontinence. J Urol. 2005;174(4 Pt 2):1633–6. discussion 1636.

    Article  PubMed  Google Scholar 

  20. Khan MK, et al. Botulinum toxin injection in the pediatric population with medically refractory neuropathic bladder. J Pediatr Urol. 2016;12(2):104 e1–6.

    Article  Google Scholar 

  21. Figueroa V, et al. Single-center experience with botulinum toxin endoscopic detrusor injection for the treatment of congenital neuropathic bladder in children: effect of dose adjustment, multiple injections, and avoidance of reconstructive procedures. J Pediatr Urol. 2014;10(2):368–73.

    Article  CAS  PubMed  Google Scholar 

  22. Choi EK, et al. Effects of intravesical electrical stimulation therapy on urodynamic patterns for children with spina bifida: a 10-year experience. J Pediatr Urol. 2013;9(6 Pt A):798–803.

    Article  PubMed  Google Scholar 

  23. Kiddoo DA, et al. Urethral dilation as treatment for neurogenic bladder. J Urol. 2006;176(4 Pt 2):1831–3. discussion 1834

    Article  PubMed  Google Scholar 

  24. Schlomer BJ, Saperston K, Baskin L. National trends in augmentation cystoplasty in the 2000s and factors associated with patient outcomes. J Urol. 2013;190(4):1352–7.

    Article  PubMed  Google Scholar 

  25. Husmann D.A. Lessons learned from the management of adults who have undergone augmentation for spina bifida and bladder exstrophy: incidence and management of the non-lethal complications of bladder augmentation. Int J Urol, 2017.

  26. Szymanski KM, et al. Mortality after bladder augmentation in children with spina bifida. J Urol. 2015;193(2):643–8.

    Article  PubMed  Google Scholar 

  27. Szymanski KM, et al. Long-term outcomes of catheterizable continent urinary channels: what do you use, where you put it, and does it matter? J Pediatr Urol. 2015;11(4):210 e1–7.

    Article  Google Scholar 

  28. Snodgrass W, et al. Upper tract changes in patients with neurogenic bladder and sustained pressures > 40 cm following bladder neck surgery without augmentation. J Pediatr Urol. 2014;10(4):744–8.

    Article  PubMed  Google Scholar 

  29. •• Grimsby GM, et al. Long-Term Outcomes of Bladder Neck Reconstruction without Augmentation Cystoplasty in Children. J Urol. 2016;195(1):155–61. This study revised a previous analysis of patients who underwent isolated bladder neck reconstruction without augmentation with less reassuring long-term results. At a mean 4.9 years follow-up, the estimated 10 year cumulative incidence was 30% for augmentation cystoplasty, 70% for new continence procedures, more than 50% developed upper tract changes, and chronic kidney disease in 20%.

    Article  PubMed  Google Scholar 

  30. Catti M, et al. Artificial urinary sphincter in children—voiding or emptying? An evaluation of functional results in 44 patients. J Urol. 2008;180(2):690–3. discussion 693

    Article  CAS  PubMed  Google Scholar 

  31. Silveri M, et al. Endoscopic treatment for urinary incontinence in children with a congenital neuropathic bladder. Br J Urol. 1998;82(5):694–7.

    Article  CAS  PubMed  Google Scholar 

  32. Godbole P, et al. Endourethral injection of bulking agents for urinary incontinence in children. BJU Int. 2003;91(6):536–9.

    Article  CAS  PubMed  Google Scholar 

  33. Gundeti MS, et al. Robotic-assisted laparoscopic reconstructive surgery in the lower urinary tract. Curr Urol Rep. 2013;14(4):333–41.

    Article  PubMed  Google Scholar 

  34. Famakinwa OJ, Rosen AM, Gundeti MS. Robot-assisted laparoscopic Mitrofanoff appendicovesicostomy technique and outcomes of extravesical and intravesical approaches. Eur Urol. 2013;64(5):831–6.

    Article  PubMed  Google Scholar 

  35. Gundeti MS, et al. A multi-institutional study of perioperative and functional outcomes for pediatric robotic-assisted laparoscopic Mitrofanoff appendicovesicostomy. J Pediatr Urol. 2016;12(6):386 e1–5.

    Article  Google Scholar 

  36. Murthy P, et al. Robot-assisted laparoscopic augmentation ileocystoplasty and Mitrofanoff appendicovesicostomy in children: updated interim results. Eur Urol. 2015;68(6):1069–75.

    Article  PubMed  Google Scholar 

  37. Moscardi PRM, et al. Robotic-assisted laparoscopic artificial urinary sphincter and MACE procedure on a pediatric patient. J Pediatr Urol. 2017;13(5):527–8.

    Article  PubMed  Google Scholar 

  38. Tuite GF, et al. Urological outcome of the Xiao procedure in children with myelomeningocele and lipomyelomeningocele undergoing spinal cord detethering. J Urol. 2016;196(6):1735–40.

    Article  PubMed  Google Scholar 

  39. Xiao CG, et al. An artificial somatic-autonomic reflex pathway procedure for bladder control in children with spina bifida. J Urol. 2005;173(6):2112–6.

    Article  PubMed  Google Scholar 

  40. Lee B, et al. British Association of Paediatric Urologists consensus statement on the management of the neuropathic bladder. J Pediatr Urol. 2016;12(2):76–87.

    Article  CAS  PubMed  Google Scholar 

  41. • Szymanski KM, et al. All incontinence is not created equal: impact of urinary and fecal incontinence on quality of life in adults with spina bifida. J Urol. 2017;197(3 Pt 2):885–91. This study utilized a recently validated quality of life instrument specific to the SB population. The QUALAS-A is validated for adults currently, showing us long term patient-reported outcomes that reinforce both fecal and urinary incontinence lower quality of life, and has served as a starting point for the development of a validated tool for pediatric patients.

    Article  PubMed  Google Scholar 

  42. Lee NG, et al. The effect of spinal cord level on sexual function in the spina bifida population. J Pediatr Urol. 2015;11(3):142 e1–6.

    Article  Google Scholar 

  43. Choi EK, Ji Y, Han SW. Sexual function and quality of life in young men with spina bifida: could it be neglected aspects in clinical practice? Urology. 2017;108:225–32.

    Article  PubMed  Google Scholar 

  44. Arata M, et al. Pregnancy outcome and complications in women with spina bifida. J Reprod Med. 2000;45(9):743–8.

    CAS  PubMed  Google Scholar 

  45. Shepard CL, et al Pregnancy among mothers with spina bifida. J Pediatr Urol, 2017.

Download references

Author information

Authors and Affiliations

  1. Division of Urology, The Children’s Hospital of Philadelphia, University of Pennsylvania, 3rd Floor, Wood Building, 34th and Civic Center Blvd, Philadelphia, PA, 19104, USA

    Diana K. Bowen MD & Dana A. Weiss MD

Authors
  1. Diana K. Bowen MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Dana A. Weiss MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Dana A. Weiss MD.

Ethics declarations

Conflict of Interest

Diana K. Bowen declares that she has no conflict of interest. Dana A. Weiss declares that she has no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical Collection on Urology

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Bowen, D.K., Weiss, D.A. Contemporary Management of Neurogenic Bladder in Children. Curr Treat Options Peds 4, 14–23 (2018). https://doi.org/10.1007/s40746-018-0117-0

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40746-018-0117-0

Keywords

Search

Navigation