Current Management of Childhood Neuropathic Bladder:Review of 156 Cases

Abstract

Management of neuropathic bladder aims to maintain renal function and to secure appliance-free continence; because of recent advances, both objectives are theoretically attainable. Our present scheme of management, based upon preliminary video-urodynamic assessment, is outlined. In the years 1984-1988 we treated 156 children suffering from neuropathic bladder. In 5 per cent of cases the upper renal tracts have deteriorated on treatment; in patients presenting with upper tract dilatation, improvement has been obtained in 68 per cent. A quarter of the patients were considered too generally disabled to achieve appliance-free continence; these have been managed by penile appliance, indwelling urethral catheter or, occasionally, urinary diversion. For three-quarters of the patients, most ambulant, appliance-free continence was the goal; 68 per cent have been managed nonsurgically and 32 per cent surgically. Reliable day-time continence has been achieved in 78 per cent of the former and 86 per cent of the latter, 80 per cent overall.

The anocutaneous reflex and urinary continence in children with myelomeningocele

“…CISC effectively treats urinary incontinence in patients with a neuropathic bladder only when the bladder has adequate functional capacity. Such capacity may be lacking as a result of detrusor hyper‐reflexia, detrusor noncompliance, sphincteric incompetence or any combination of these factors, and it is well recognized that among them sphincteric incompetence is the most difficult to treat, whether medically or surgically [1–4]. Moreover, surgical treatment of sphincteric incompetence may call for simultaneous augmentation cystoplasty, to protect the subsequent integrity of the upper renal tracts [3,4].…”