Contemporary Management of Neurogenic Bladder in Children
- 18 Downloads
Purpose of review
The management of neurogenic bladder (NGB) is an evolving task that derives its principles from the long-term goals of renal protection and optimization of quality of life. This review describes contemporary diagnostic techniques as well as expanding treatment options.
Innovation within the field has chiefly been in the form of new modalities for maintaining low bladder pressures and developing minimally invasive approaches to surgical reconstruction. A new and quickly expanding area of interest is “transitional care” (also known as congenitalism) for the aging pediatric patient with NGB with a particular emphasis on establishing adequate adult care for medical and urologic needs.
Adhering to timeless principles while innovating in the field to maximize quality of care is critical to continue to provide the best care for NGB patients.
KeywordsNeurogenic bladder Spina bifida Transitional care
Compliance with Ethical Standards
Conflict of Interest
Diana K. Bowen declares that she has no conflict of interest. Dana A. Weiss declares that she has no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
References and Recommended Reading
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 13.• Ouyang L, et al. Characteristics and survival of patients with end stage renal disease and spina bifida in the United States renal data system. J Urol. 2015;193(2):558–64. This matched cohort study used the US Renal Data System to compare SB patients who developed ESRD to the rest of the population over a four year period. SB patients were younger (41 vs. 62 years) and less likely to undergo renal transplantation however mortality overall was not affected. This underscores the importance of contemporary management continuing to focus on renal protection.CrossRefPubMedGoogle Scholar
- 21.Figueroa V, et al. Single-center experience with botulinum toxin endoscopic detrusor injection for the treatment of congenital neuropathic bladder in children: effect of dose adjustment, multiple injections, and avoidance of reconstructive procedures. J Pediatr Urol. 2014;10(2):368–73.CrossRefPubMedGoogle Scholar
- 25.Husmann D.A. Lessons learned from the management of adults who have undergone augmentation for spina bifida and bladder exstrophy: incidence and management of the non-lethal complications of bladder augmentation. Int J Urol, 2017.Google Scholar
- 29.•• Grimsby GM, et al. Long-Term Outcomes of Bladder Neck Reconstruction without Augmentation Cystoplasty in Children. J Urol. 2016;195(1):155–61. This study revised a previous analysis of patients who underwent isolated bladder neck reconstruction without augmentation with less reassuring long-term results. At a mean 4.9 years follow-up, the estimated 10 year cumulative incidence was 30% for augmentation cystoplasty, 70% for new continence procedures, more than 50% developed upper tract changes, and chronic kidney disease in 20%.CrossRefPubMedGoogle Scholar
- 41.• Szymanski KM, et al. All incontinence is not created equal: impact of urinary and fecal incontinence on quality of life in adults with spina bifida. J Urol. 2017;197(3 Pt 2):885–91. This study utilized a recently validated quality of life instrument specific to the SB population. The QUALAS-A is validated for adults currently, showing us long term patient-reported outcomes that reinforce both fecal and urinary incontinence lower quality of life, and has served as a starting point for the development of a validated tool for pediatric patients.CrossRefPubMedGoogle Scholar
- 45.Shepard CL, et al Pregnancy among mothers with spina bifida. J Pediatr Urol, 2017.Google Scholar