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Pediatric Nephrology

, Volume 23, Issue 6, pp 889–896 | Cite as

Treatment of the neurogenic bladder in spina bifida

  • Tom P. V. M. de Jong
  • Rafal Chrzan
  • Aart J. Klijn
  • Pieter DikEmail author
Educational Feature

Abstract

Renal damage and renal failure are among the most severe complications of spina bifida. Over the past decades, a comprehensive treatment strategy has been applied that results in minimal renal scaring. In addition, the majority of patients can be dry for urine by the time they go to primary school. To obtain such results, it is mandatory to treat detrusor overactivity from birth onward, as upper urinary tract changes predominantly start in the first months of life. This means that new patients with spina bifida should be treated from birth by clean intermittent catheterization and pharmacological suppression of detrusor overactivity. Urinary tract infections, when present, need aggressive treatment, and in many patients, permanent prophylaxis is indicated. Later in life, therapy can be tailored to urodynamic findings. Children with paralyzed pelvic floor and hence urinary incontinence are routinely offered surgery around the age of 5 years to become dry. Rectus abdominis sling suspension of the bladder neck is the first-choice procedure, with good to excellent results in both male and female patients. In children with detrusor hyperactivity, detrusorectomy can be performed as an alternative for ileocystoplasty provided there is adequate bladder capacity. Wheelchair-bound patients can manage their bladder more easily with a continent catheterizable stoma on top of the bladder. This stoma provides them extra privacy and diminishes parental burden. Bowel management is done by retrograde or antegrade enema therapy. Concerning sexuality, special attention is needed to address expectations of adolescent patients. Sensibility of the glans penis can be restored by surgery in the majority of patients.

Keywords

Spina bifida Surgical treatment Incontinence Renal function Bladder augmentation Bladder-neck sling Dryness Antimuscarinic 

Notes

Supplementary material

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Copyright information

© The Author(s) 2008

Open AccessThis is an open access article distributed under the terms of the Creative Commons Attribution Noncommercial License (https://doi.org/creativecommons.org/licenses/by-nc/2.0), which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited.

Authors and Affiliations

  • Tom P. V. M. de Jong
    • 1
  • Rafal Chrzan
    • 1
  • Aart J. Klijn
    • 1
  • Pieter Dik
    • 1
    Email author
  1. 1.Pediatric Renal Center, Department of Pediatric UrologyUniversity Children’s Hospital, UMCUUtrechtThe Netherlands

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