Cerebral palsy, neurogenic bladder, and outcomes of lifetime care

Abstract

ABBREVIATION SNB Symptomatic neurogenic bladderAIM To determine the prevalence of symptomatic neurogenic bladder (SNB) and social and functional variables in a large sample of people with cerebral palsy (CP).METHOD The medical records of 214 individuals (96 females, 118 males) with CP between the years 1990 and 2000 were retrospectively reviewed. Individuals with frequency, urgency, or incontinence were assigned Gross Motor Function Classification System levels and underwent cystometrogram ⁄ electromyelogram studies. Neurogenic bladders were classified according to the nomenclature of the International Continence Society.RESULTS Fifty-two patients had hemiplegia, 42 diplegia, 117 quadriplegia, and three dyskinesia.Educational levels ranged from full special education to those with graduate degrees. Thirty-five individuals in our group aged 5 to 66 years had SNB with a prevalence of 16.4%. The median age for the entire population was 9 years 7 months and for those with SNB 12 years 4 months (range 5-57y). Over 80% of individuals who underwent investigation were found to have spastic hyperreflexic type bladders. Ninety-one percent obtained total continence or major improvement with conservative care. SNB was documented across the lifespan, educational spectrum, and functional level. Upper urinary tract pathology was infrequent.INTERPRETATION SNB is a common finding in individuals with CP. In most patients it is readily diagnosed and treated with conservative interventions.Incontinence has long been identified as a problem in people with cerebral palsy (CP).1-3 Neurogenic bladder has been associated with incontinence in the population with CP and is the focus of several studies. [4][5][6] McNeal et al.7 from the University of Iowa screened 50 patients with CP and 18 patients with one or more symptoms indicative of a neurogenic bladder were identified. At least four were found to have a neurogenic bladder on urological assessment including cystometrograms. Significant improvement was identified in symptomatic patients on medication.Decter et al. 8 from Boston evaluated voiding functions including cystometrograms and electromyography findings of the external urinary sphincter in 57 children with CP. Eightysix percent of the children had evidence of an upper motorneuron injury. Treatment protocols achieved continence in more than 75% of the children.Studies by Drigo et al., 9 Karaman et al., 10 and Bross et al. 11of children with CP all found urodynamic features consistent with neurogenic bladder, detrusor sphincter dyssynergia, and upper motoneuron etiology. As noted by Borzyskowski,12 there are many factors involved in bladder control in people with CP. These factors include age, cognitive and communication skills, mobility, and upper extremity function together with expectations, training, and a compatible living environment. Incontinence in the population with CP is, thus, much more complicated than a static pathology of the central nervous system and associated measured bladder function.The purpose of this study ...

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