EAU/ESPU guidelines on the management of neurogenic bladder in children and adolescent part I diagnostics and conservative treatment

Stein, Raimund; Bogaert, Guy; Doğan, Hasan Serkan; Hoen, Lisette A. ’t; Kočvara, R; Nijman, Rien J.M.; Quadackers, Josine S. L. T.; Rawashdeh, Yazan F.; Sılay, Mesrur Selçuk; Tekgül, Serdar; Radmayr, Christian

doi:10.1002/nau.24211

Cited by 108 publications

(113 citation statements)

References 113 publications

(180 reference statements)

Supporting

Mentioning

103

Contrasting

Unclassified

Order By: Relevance

“…CIC in combination with anticholinergics (oxybutynin) had been considered the standard therapy for children with NBD with detrusor hyperactivity[ 8 , 9 ]. This treatment is feasible and effective in developing countries, where untreated neuropathic bladder is an important cause of preventable chronic renal failure[ 10 , 11 ].…”

Section: Management Of Nbd In Childrenmentioning

confidence: 99%

Lower urinary tract dysfunction in pediatrics progress to kidney disease in adolescents: Toward precision medicine in treatment

Wishahi¹

2021

WJN

View full text Add to dashboard Cite

Newborn infants who had neurogenic bladder dysfunction (NBD) have a normal upper urinary tract at birth. Most of them will develop deterioration of renal function and chronic kidney disease if they do not receive proper management. Children with NBD can develop renal damage at adolescence or earlier, which is due to high detrusor pressures resulted from poor compliance of the bladder, detrusor overactivity against a closed sphincter or detrusor sphincter dyssynergia. To preserve renal function and prevent deterioration of the kidneys, NBD must be treated immediately after being diagnosed. Over the last few years there was great progress in the treatment of children with the NBD. We searched PubMed and the Cochrane Library for peer-reviewed articles published in any language up to March 10, 2021, using the search term “neurogenic bladder children.” Our search excluded diagnosis, pathophysiology, surgical treatment of spinal cord injury and spina bifida. The research identified the effectiveness of treatment regimens targeting prevention of chronic kidney disease and the indications of kidney transplantation. The results of the research showed that NBD in children should be diagnosed early in life, and the child should receive the proper management. The literature search concluded that the management of NBD in children would be personalized for every case and could be changed according to response to treatment, side effects, child compliance, availability of treatment modality and costs of treatment. The objectives of the study are to present the different options of management of NBD in children and the selection of the proper method in a personalized manner.

show abstract

Section: Management Of Nbd In Childrenmentioning

confidence: 99%

Lower urinary tract dysfunction in pediatrics progress to kidney disease in adolescents: Toward precision medicine in treatment

Wishahi¹

2021

WJN

View full text Add to dashboard Cite

show abstract

“… 17 In addition, some entities, such as the European Society for Paediatric Urology, recommend a baseline DMSA scan within the first year of life to detect renal scarring. 18 The argument for baseline DMSA is that ultrasound has been found to have poor correlation with renal scars and almost half of older patients with neurogenic bladders have renal scarring. 19 …”

Section: Diagnosticsmentioning

confidence: 99%

“… 22 Of note, VCUG would be performed along with a cystometrogram if UDS is not available. 18 In the expectant management practice of neurogenic bladder in children with spina bifida, routine RBUS is repeated on a follow-up surveillance schedule. If evidence of upper tract deterioration (eg, new or worsened hydronephrosis) is eventually found on imaging, it serves as the impetus for intervention beginning with UDS and subsequent initiation of CIC, medications, or surgery.…”

Section: Diagnosticsmentioning

confidence: 99%

The Importance of Early Diagnosis and Management of Pediatric Neurogenic Bladder Dysfunction

Hobbs

Krischak

Tejwani

et al. 2021

RRU

View full text Add to dashboard Cite

Neurogenic bladder dysfunction is a major source of urologic morbidity in children, especially in those with spina bifida (SB). Complications from progression of bladder dysfunction can include urinary tract infections (UTIs), urinary incontinence, upper tract deterioration, and renal dysfunction or failure. In these children, there has been a recent trend toward proactive rather than expectant management of neurogenic bladder. However, there is a lack of consensus on how to best achieve the three main goals of neurogenic bladder management: 1) preserving kidney function, 2) achieving continence (if desired by the family/individual), and 3) achieving social and functional urologic independence (if appropriate). Hence, our objective was to perform a narrative literature review to evaluate the approaches to diagnosis and management of pediatric neurogenic bladder dysfunction, with special focus on children with SB. The approach strategies vary across a spectrum, with a proactive strategy on one end of the spectrum and an expectant strategy at the other end. The proactive management strategy is characterized by early and frequent labs, imaging, and urodynamic (UDS) evaluation, with early initiation of clean intermittent catheterization (CIC) and proceeding with pharmacotherapy, or surgery if indicated. The expectant management strategy prioritizes surveillance labs and imaging prior to proceeding with invasive assessments and interventions such as UDS or pharmacotherapy. Both treatment strategies are currently utilized and data have historically been inconclusive in demonstrating efficacy of one regimen over the other. We performed a narrative literature evaluating proactive and expectant treatment strategies as they relate to diagnostics and management of Spina Bifida. From the available literature and our practice, a proactive strategy favors greater benefit in preventative management and may decrease risk of renal dysfunction compared with expectant management.

show abstract

“…Since most TCS-associated urological morbidities as well as mortalities are caused by renal dysfunction due to elevated bladder pressure, the primary objectives of urological evaluation involves early recognition of elevated bladder pressure or identifying the cases that would exhibit a high risk for changes. Adequate proactive treatment has been reported to be effective in preventing the development of renal injury and subsequent renal functional loss 8) . Thus, identifying the patients who are likely to show deterioration is crucial.…”

Section: Goal Of Urological Evaluationmentioning

confidence: 99%

“…This investigation might vary according to the developmental and functional status of the patients and their risk of deterioration. Since such individual risk stratification has not been well defined, some follow-up schedules 6,8) that have been recommended might not be applicable for others. In addition, this is not the main concern for neurosurgeons who would be the main readers of the paper.…”

Section: Introductionmentioning

confidence: 99%

Urological Evaluation of Tethered Cord Syndrome

Park

2020

J Korean Neurosurg Soc

View full text Add to dashboard Cite

To describe how to perform urological evaluation in children with tethered cord syndrome (TCS). Although a common manifestation of TCS is the development of neurogenic bladder in developing children, neurosurgeons often face difficulty in detecting urological problems in patients with TCS. From a urological perspective, diagnosis of TCS in developing children is further complicated due to the differentiation between neurogenic bladder dysfunctions and transient bladder dysfunctions owing to developmental problems. Due to the paucity of evidence regarding evaluation prior to and after untethering, I have shown the purpose and tools for evaluation in my own practice. This may be tailored to the types of neurogenic bladder, developmental status, and risks for deterioration. While the urodynamic study (UDS) is the gold standard test for understanding bladder function, it is not a panacea in revealing the nature of bladder dysfunction. In addition, clinicians should consider the influence of developmental processes on bladder function. Before untethering, UDS should reveal synergic urethral movement, which indicates an intact sacral reflex and lack of TCS. Postoperatively, the measurement of post-void residual urine volume is a key factor for the evaluation of spontaneous voiders. In case of elevation, fecal impaction, which is common in spinal dysraphism, should be addressed. In patients with clean intermittent catheterization, the frequency-volume chart should be monitored to assess the storage function of the bladder. Toilet training is an important sign of maturation, and its achievement should be monitored. Signs of bladder deterioration should be acknowledged, and follow-up schedule should be tailored to prevent upper urinary tract damage and also to determine an adequate timing for intervention. Neurosurgeons should be aware of urological problems related to TCS as well as urologists. Cooperation and regular discussion between the two disciplines could enhance the quality of patient care. Accumulation of experience will improve follow-up strategies.

show abstract

EAU/ESPU guidelines on the management of neurogenic bladder in children and adolescent part I diagnostics and conservative treatment

Cited by 108 publications

References 113 publications

Lower urinary tract dysfunction in pediatrics progress to kidney disease in adolescents: Toward precision medicine in treatment

Lower urinary tract dysfunction in pediatrics progress to kidney disease in adolescents: Toward precision medicine in treatment

The Importance of Early Diagnosis and Management of Pediatric Neurogenic Bladder Dysfunction

Urological Evaluation of Tethered Cord Syndrome

Contact Info

Product

Resources

About