Neurogenic Bladder: Myelomeningocele, Occult Spina Bifida, and Tethered Cord

  • Pieter DikEmail author
  • Laetitia M. O. de Kort
  • Paul W. Veenboer
Part of the Urodynamics, Neurourology and Pelvic Floor Dysfunctions book series (UNPFD)


Spinal dysraphism occurs in patients with spina bifida aperta or occulta and will affect the functionality of bladder and sphincter complex. The incidence has changed over the past decades from 1:3000 live births to 1:6000 as a result of the use of folic acid and also as a result of early abortion.

Treatment is directed to preservation of bladder and kidney function. As long as bladder volume with low pressures is achieved, kidney function will be fine. Low pressures are possible by using antimuscarinic medication or in some cases operations. Intermittent catheterization is needed to ensure proper bladder evacuation. In most cases, it is possible to become dry in between catheterization, or perhaps some incontinence remains during transfers or straining.

Colonic washouts have improved the quality of life dramatically: almost all patients can obtain pseudo-continence for stool.

Since a few years, it is possible to restore some sexual function by making a neural bypass between an ilioinguinal nerve and a dorsal nerve of the penis.

Attention for tethering and scarring of kidneys is the mainstay of the treatment.


  1. 1.
    Smith GK. The history of spina bifida, hydrocephalus, paraplegia, and incontinence. Pediatr Surg Int. 2001;17(5–6):424–32.CrossRefPubMedGoogle Scholar
  2. 2.
    Simpson D. Nicolaes Tulp and the golden age of the Dutch Republic. ANZ J Surg. 2007;77(12):1095–101.CrossRefPubMedGoogle Scholar
  3. 3.
    Akalan N. Myelomeningocele (open spina bifida) - surgical management. Adv Tech Stand Neurosurg. 2011;37:113–41.CrossRefGoogle Scholar
  4. 4.
    Schorah C. Dick Smithells, folic acid, and the prevention of neural tube defects. Birth Defects Res A Clin Mol Teratol. 2009;85(4):254–9.CrossRefPubMedGoogle Scholar
  5. 5.
    Lapides J, Diokno AC, Silber SJ, Lowe BS. Clean, intermittent self-catheterization in the treatment of urinary tract disease. J Urol. 1972;107(3):458–61.CrossRefPubMedGoogle Scholar
  6. 6.
    Dik P, Klijn AJ, van Gool JD, de Jong-de Vos van Steenwijk CC, de Jong TP. Early start to therapy preserves kidney function in spina bifida patients. Eur Urol. 2006;49(5):908–13.CrossRefPubMedGoogle Scholar
  7. 7.
    Adzick NS, Thom EA, Spong CY, Brock JW 3rd, Burrows PK, Johnson MP, et al. A randomized trial of prenatal versus postnatal repair of myelomeningocele. N Engl J Med. 2011;364(11):993–1004.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    de Jong TP, Chrzan R, Klijn AJ, Dik P. Treatment of the neurogenic bladder in spina bifida. Pediatr Nephrol. 2008;23(6):889–96.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Woodhouse CR. Myelomeningocele in young adults. BJU Int. 2005;95(2):223–30.CrossRefPubMedGoogle Scholar
  10. 10.
    Coulthard MG, Verber I, Jani JC, Lawson GR, Stuart CA, Sharma V, et al. Can prompt treatment of childhood UTI prevent kidney scarring? Pediatr Nephrol. 2009;24(10):2059–63.CrossRefPubMedGoogle Scholar
  11. 11.
    Veenboer PW, Hobbelink MG, Ruud Bosch JL, Dik P, van Asbeck FW, Beek FJ, et al. Diagnostic accuracy of Tc-99m DMSA scintigraphy and renal ultrasonography for detecting renal scarring and relative function in patients with spinal dysraphism. Neurourol Urodyn. 2015;34(6):513–8.CrossRefPubMedGoogle Scholar
  12. 12.
    Filler G, Gharib M, Casier S, Lodige P, Ehrich JH, Dave S. Prevention of chronic kidney disease in spina bifida. Int Urol Nephrol. 2012;44(3):817–27.CrossRefPubMedGoogle Scholar
  13. 13.
    Choi EK, Shin SH, Im YJ, Kim MJ, Han SW. The effects of transanal irrigation as a stepwise bowel management program on the quality of life of children with spina bifida and their caregivers. Spinal Cord. 2013;51(5):384–8.CrossRefPubMedGoogle Scholar
  14. 14.
    Bauer SB, Joseph DB. Management of the obstructed urinary tract associated with neurogenic bladder dysfunction. Urol Clin North Am. 1990;17(2):395–406.PubMedPubMedCentralGoogle Scholar
  15. 15.
    Oakeshott P, Hunt GM, Poulton A, Reid F. Expectation of life and unexpected death in open spina bifida: a 40-year complete, non-selective, longitudinal cohort study. Dev Med Child Neurol. 2010;52(8):749–53.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Woodhouse CR, Neild GH, RN Y, Bauer S. Adult care of children from pediatric urology. J Urol. 2012;187(4):1164–71.CrossRefPubMedGoogle Scholar
  17. 17.
    Ahmad I, Granitsiotis P. Urological follow-up of adult spina bifida patients. Neurourol Urodyn. 2007;26(7):978–80.CrossRefPubMedGoogle Scholar
  18. 18.
    Husmann DA. Long-term complications following bladder augmentations in patients with spina bifida: bladder calculi, perforation of the augmented bladder and upper tract deterioration. Transl Androl Urol. 2016;5(1):3–11.PubMedPubMedCentralGoogle Scholar
  19. 19.
    Zegers B, Uiterwaal C, Kimpen J, van Gool J, de Jong T, Winkler-Seinstra P, et al. Antibiotic prophylaxis for urinary tract infections in children with spina bifida on intermittent catheterization. J Urol. 2011;186(6):2365–70.CrossRefPubMedGoogle Scholar
  20. 20.
    Robinson JL, Finlay JC, Lang ME, Bortolussi R, Canadian Paediatric Society, Community Paediatrics Committee, Infectious Diseases and Immunization Committee. Prophylactic antibiotics for children with recurrent urinary tract infections. Paediatr Child Health. 2015;20(1):45–7.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Defoor W, Ferguson D, Mashni S, Creelman L, Reeves D, Minevich E, et al. Safety of gentamicin bladder irrigations in complex urological cases. J Urol. 2006;175(5):1861–4.CrossRefPubMedGoogle Scholar
  22. 22.
    Durham SH, Stamm PL, Eiland LS. Cranberry products for the prophylaxis of urinary tract infections in pediatric patients. Ann Pharmacother. 2015;49(12):1349–56.CrossRefPubMedGoogle Scholar
  23. 23.
    Blais AS, Bergeron M, Nadeau G, Ramsay S, Bolduc S. Anticholinergic use in children: persistence and patterns of therapy. Can Urol Assoc J. 2016;10(3–4):137–40.CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Dorsher PT, McIntosh PM. Neurogenic bladder. Adv Urol. 2012;2012:816274. Scholar
  25. 25.
    Veenboer PW, Huisman J, Chrzan RJ, Kuijper CF, Dik P, de Kort LM, et al. Behavioral effects of long-term antimuscarinic use in patients with spinal dysraphism: a case control study. J Urol. 2013;190(6):2228–32.CrossRefPubMedGoogle Scholar
  26. 26.
    Nardulli R, Losavio E, Ranieri M, Fiore P, Megna G, Bellomo RG, et al. Combined antimuscarinics for treatment of neurogenic overactive bladder. Int J Immunopathol Pharmacol. 2012;25(1 Suppl):35S–41S.CrossRefPubMedGoogle Scholar
  27. 27.
    Morin F, Blais AS, Nadeau G, Moore K, Genois L, Bolduc S. Dual therapy for refractory overactive bladder in children: a prospective open-label study. J Urol. 2017;197(4):1158–63.CrossRefPubMedGoogle Scholar
  28. 28.
    Buyse G, Waldeck K, Verpoorten C, Bjork H, Casaer P, Andersson KE. Intravesical oxybutynin for neurogenic bladder dysfunction: less systemic side effects due to reduced first pass metabolism. J Urol. 1998;160(3 Pt 1):892–6.PubMedGoogle Scholar
  29. 29.
    Staskin DR, Salvatore S. Oxybutynin topical and transdermal formulations: an update. Drugs Today (Barc). 2010;46(6):417–25.CrossRefGoogle Scholar
  30. 30.
    Krause P, Fuhr U, Schnitker J, Albrecht U, Stein R, Rubenwolf P. Pharmacokinetics of intravesical versus oral oxybutynin in healthy adults: results of an open label, randomized, prospective clinical study. J Urol. 2013;190(5):1791–7.CrossRefPubMedGoogle Scholar
  31. 31.
    Scheepe JR, Blok BF, ‘t Hoen LA. Applicability of botulinum toxin type A in paediatric neurogenic bladder management. Curr Opin Urol. 2017;27(1):14–9.CrossRefPubMedGoogle Scholar
  32. 32.
    Del Popolo G, Filocamo MT, Li Marzi V, Macchiarella A, Cecconi F, Lombardi G, et al. Neurogenic detrusor overactivity treated with english botulinum toxin a: 8-year experience of one single centre. Eur Urol. 2008;53(5):1013–9.CrossRefPubMedGoogle Scholar
  33. 33.
    Highlights of prescribing information [Internet]. Available from:
  34. 34.
    Dik P, Klijn AJ, van Gool JD, de Jong TP. Transvaginal sling suspension of bladder neck in female patients with neurogenic sphincter incontinence. J Urol. 2003;170(2 Pt 1):580,1. discussion 581-2Google Scholar
  35. 35.
    Saikaly SK, Rich MA, Swana HS. Assessment of pediatric Malone antegrade continence enema (MACE) complications: effects of variations in technique. J Pediatr Urol. 2016;12(4):246.e1–6.CrossRefGoogle Scholar
  36. 36.
    Veenboer PW, Nadorp S, de Jong TP, Dik P, van Asbeck FW, Bosch JL, et al. Enterocystoplasty vs detrusorectomy: outcome in the adult with spina bifida. J Urol. 2013;189(3):1066–70.CrossRefPubMedPubMedCentralGoogle Scholar
  37. 37.
    Dik P, Tsachouridis GD, Klijn AJ, Uiterwaal CS, de Jong TP. Detrusorectomy for neuropathic bladder in patients with spinal dysraphism. J Urol. 2003;170(4 Pt 1):1351–4.CrossRefPubMedGoogle Scholar
  38. 38.
    Polm PD, de Kort, Laetitia M. O., de Jong, Tom P. V. M., Dik P. Langetermijn follow-up van katheteriseerbare vesicostoma’s bij kinderen, een vergelijking van verschillende technieken. Tijdschr Urol. 2017:1–4.Google Scholar
  39. 39.
    Veenboer PW, Bosch JL, van Asbeck FW, de Kort LM. Upper and lower urinary tract outcomes in adult myelomeningocele patients: a systematic review. PLoS One. 2012;7(10):e48399.CrossRefPubMedPubMedCentralGoogle Scholar
  40. 40.
    Ab E, Dik P, Klijn AJ, van Gool JD, de Jong TP. Detrusor overactivity in spina bifida: how long does it need to be treated? Neurourol Urodyn. 2004;23(7):685–8.CrossRefPubMedGoogle Scholar
  41. 41.
    Veenboer PW, Bosch JL, Rosier PF, Dik P, van Asbeck FW, de Jong TP, et al. Cross-sectional study of determinants of upper and lower urinary tract outcomes in adults with spinal dysraphism--new recommendations for urodynamic followup guidelines? J Urol. 2014;192(2):477–82.CrossRefPubMedGoogle Scholar
  42. 42.
    Marks BK, Goldman HB. Videourodynamics: indications and technique. Urol Clin North Am. 2014;41(3):383,91, vii-viii.CrossRefGoogle Scholar
  43. 43.
    McGuire EJ, Woodside JR, Borden TA. Upper urinary tract deterioration in patients with myelodysplasia and detrusor hypertonia: a followup study. J Urol. 1983;129(4):823–6.CrossRefPubMedGoogle Scholar
  44. 44.
    Snow-Lisy DC, Yerkes EB, Cheng EY. Update on urological management of spina bifida from prenatal diagnosis to adulthood. J Urol. 2015;194(2):288–96.CrossRefPubMedGoogle Scholar
  45. 45.
    von Linstow ME, Biering-Sorensen I, Liebach A, Lind M, Seitzberg A, Hansen RB, et al. Spina bifida and sexuality. J Rehabil Med. 2014;46(9):891–7.CrossRefGoogle Scholar
  46. 46.
    Verhoef M, Barf HA, Vroege JA, Post MW, Van Asbeck FW, Gooskens RH, et al. Sex education, relationships, and sexuality in young adults with spina bifida. Arch Phys Med Rehabil. 2005;86(5):979–87.CrossRefPubMedGoogle Scholar
  47. 47.
    Overgoor ML, de Jong TP, Cohen-Kettenis PT, Edens MA, Kon M. Increased sexual health after restored genital sensation in male patients with spina bifida or a spinal cord injury: the TOMAX procedure. J Urol. 2013;189(2):626–32.CrossRefPubMedGoogle Scholar
  48. 48.
    Haakma W, Dik P, ten Haken B, Froeling M, Nievelstein RA, Cuppen I, et al. Diffusion tensor magnetic resonance imaging and fiber tractography of the sacral plexus in children with spina bifida. J Urol. 2014;192(3):927–33.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Pieter Dik
    • 1
    Email author
  • Laetitia M. O. de Kort
    • 2
  • Paul W. Veenboer
    • 2
  1. 1.Department of Pediatric Urology, Wilhelmina Children’s HospitalUtrechtThe Netherlands
  2. 2.Department of Urology, University Medical Center UtrechtUtrechtThe Netherlands

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