Neurogene Blasenfunktionsstörungen bei Patienten mit Meningomyelozele

Abstract

The treatment of children and adolescents with meningomyelocele has experienced a clear change in the last 30 years. The establishment of pharmacotherapy, clean intermittent catheterization (CIC) and infection prophylaxis have improved the prognosis for patients and have led to new therapeutic strategies. The interdisciplinary cooperation between neonatologists, neurosurgeons, pediatric neurologists, pediatric urologists, pediatric nephrologists, pediatric orthopedists and pediatric surgeons leads to optimization of individualized therapy. These guidelines present definitions and classifications, investigations and timing which are described in detail. The conservative and operative therapy options for neurogenic bladder function disorders are described and discussed with reference to the current literature. The brief overview provides in each case assistance for the treating physician in the care of this patient group and facilitates the interdisciplinary cooperation.

The Current Role of Botox in a Pediatric Neurogenic Bladder Condition

“…Both are caused by detrusor overactivity (DO). Decrease in storage pressure could be gained by correcting DO and increasing bladder compliance [3,6,[8][9][10][11][12][13][14][15].…”

“…The neurogenic DO is most commonly seen in children with SD and spinal cord injury but can also be seen in patients with cerebral palsy. In the majority of cases in the literature, urinary incontinence among patients with underlying neurological conditions was found to be associated with DO [6,8,9,12].…”

“…CIC empties the bladder completely without any residual urine and by this, it is decreasing the risk of urinary tract infections and keeps the child safe of vesico-ureteric reflux due to high voiding pressure. In older children, it is a valuable tool to keep the child dry [1,3,8,12,13].…”

Pharmacotherapy for Pediatric Neurogenic Bladder

“…Ideally, CIC with or without pharmacotherapy is started early based on urodynamic findings, before the development of upper tract changes. Proactive bladder treatment with the prophylactic institution of intermittent catheterization and pharmacologic, anticholinergic therapy in the newborn significantly reduced the incidence of complication development, upper urinary tract deterioration, and need for surgical intervention [ 7 , 9 , 30 , 43 – 45 ].…”

“…Of greatest significance in children with NB is determining the value of leak point pressure (LPP). LPP >40 cm H 2 O is considered dangerous [ 28 – 30 ].…”