The neurogenic bladder: medical treatment

Abstract

Neurogenic bladder sphincter dysfunction (NBSD) can cause severe and irreversible renal damage and bladder-wall destruction years before incontinence becomes an issue. Therefore, the first step in adequate management is to recognize early the bladder at risk for upper-and lower-tract deterioration and to start adequate medical treatment proactively. Clean intermittent catheterization combined with anticholinergics (oral or intravesical) is the standard therapy for NBSD. Early institution of such treatment can prevent both renal damage and secondary bladder-wall changes, thereby potentially improving longterm outcomes. In children with severe side effects or with insufficient suppression of detrusor overactivity despite maximal dosage of oral oxybutynin, intravesical instillation is an effective alternative. Intravesical instillation eliminates systemic side effects by reducing the first-pass metabolism and, compared with oral oxybutynin, intravesical oxybutynin is a more potent and long-acting detrusor suppressor. There is growing evidence that with early adequate treatment, kidneys are saved and normal bladder growth can be achieved in children so they will no longer need surgical bladder augmentation to achieve safe urinary continence in adolescence and adulthood.

The paediatric neuropathic bladder

“…This diagnostic assessment allows each child to be categorised into one of four subtypes of neuropathic bladder dysfunction based on sphincter and detrusor muscle activity (Table 1). [3] Although these categories may…”

“…It is widely used, and long-term treatment supports its safety in children, including newborns. [3] The limitations of oral anticholinergic use are the associated side-effects and that a subset of children fail to adequately respond to this therapy. Inadequate responses are characterised by ongoing urinary incontinence, which can reduce quality of life and cause progressive upper-tract dilatation and loss of renal cortical mass.…”

Urinary tract infection and bacteriuria in children performing clean intermittent catheterization with reused catheters

“…1,2 Drawing from the experience of adult patients with spinal cord injury, the introduction of clean intermittent catheterization (CIC) by Lapides et al 3 in 1972, has revolutionized the management of neurogenic bladders in children and has led to the preservation of renal function as well as improved quality of life by achieving urinary dryness by school age. 4 Intermittent catheterization is the method of choice for emptying the bladder in cases of neurogenic bladder dysfunction. To date, there is no consensus on the ideal technique or type of catheter for intermittent catheterization.…”

Continent catheterizable conduits in pediatric urology: One-center experience

“…Other causes, such as developmental defects (an imperforate anus, sacral tumors or sacral agenesis), accidental injuries or spinal tumors are rare. [1][2][3] In children with severe bladder dysfunction, the therapeutic strategy is focused on 2 tasks: preservation of renal function and control of micturition, maintaining urinary continence. For those purposes, a continent, low-pressure, high-volume bladder is essential.…”

“…This is achieved by ensuring complete emptying of the bladder. [1][2][3] Since 1972, clean intermittent catheterization (CIC) has been the standard treatment for patients who are unable to empty the bladder. 4 If catheterization through the urethra is problematic or in rare cases of the absence of the urethra, a continent vesicostomy (CVS) is performed to create a continent catheterizable conduit (CCC).…”