Neurogenic Bladder in Children Treatment, Symptoms, Causes, Diagnosis

Neurogenic Bladder in Children Treatment, Symptoms, Causes, Diagnosis

What is a neurogenic bladder?

Neurogenic bladder may also be called neuropathic bladder. The muscles and nerves of the urinary system work together to hold urine in the bladder and then release it at the appropriate time. Nerves carry messages from the bladder to the brain and from the brain to the muscles of the bladder telling them either to tighten or release. In a neurogenic bladder, the nerves that are supposed to carry these messages do not work properly, essentially paralyzing the bladder.

What causes neurogenic bladder in children?

In children a neurogenic bladder may be secondary to a birth defect or it may be acquired as the result of a different problem. The following are some of the most common causes of neurogenic bladder:

  • Spina bifida. A defect that occurs during early fetal development. The defect consists of incomplete bony closure of the spinal cord through which the spinal cord may or may not protrude.
  • Spinal cord trauma
  • Central nervous system tumors

In many cases, neurogenic bladder is associated with the following:

  • Urine leakage. This often occurs when the muscles holding urine in the bladder do not get the right message.
  • Urine retention. This often happens if the muscles holding urine in the bladder do not get the message that it is time to let go.
  • Damage to the tiny blood vessels in the kidney. This often happens if the bladder becomes too full and urine backs up into the kidneys, causing extra pressure.
  • Infection of the bladder or ureters. This often results from urine that is held too long before being eliminated.

What are the symptoms of neurogenic bladder in children?

Each child may experience symptoms differently. Symptoms of neurogenic bladder may vary depending on the cause and other associated conditions. Symptoms of neurogenic bladder may resemble other conditions and medical problems. Always consult your child's doctor for a diagnosis.

How is a neurogenic bladder in children diagnosed?

In addition to a complete medical history and physical examination, diagnostic procedures for neurogenic bladder may include:

  • Urine tests

  • Urodynamic study. During this study, your child's bladder will be filled with saline so that the bladder volume and pressure may be measured. The tone or amount of contraction of the bladder can also be determined.

What is the treatment for a neurogenic bladder in children?

Specific treatment for a neurogenic bladder will be determined by your child's doctor based on:

  • Your child's age, overall health, and medical history
  • The extent of the disease
  • Your child's tolerance for specific medications, procedures, or therapies
  • Expectations for the course of the disease
  • Your opinion or preference

Treatment for Neurogenic Bladder in Children  may include:

  • Insertion of a catheter or hollow tube to empty the bladder at regular intervals
  • Prophylactic (preventive) antibiotic therapy to reduce the incidence of infection
  • Placement of an artificial sphincter. A procedure that involves placing an artificial cuff around the neck of the bladder that can be inflated to prevent urinary incontinence and deflated when it is time to empty the bladder. These children will still require intermittent catheterization to completely empty the bladder.
  • Surgery

Please consult your doctor with any questions or concerns you may have regarding your condition. 

Urologic care of the neurogenic bladder in children

Initial care of newborns with spina bifida centers on preventing bladder and upper tract damage from detrusor leak point pressure of greater than 40 cm H(2)O. The authors recommend using urodynamic-based management to select patients with elevated pressures for anticholinergic therapy and intermittent catheterization (CIC), using diapers and observation with biannual renal sonography for the remainder. At the age of toilet training, children who have urodynamic evidence of uninhibited contractions or rising pressure during filling are started on anticholinergics and CIC, or have their dosage increased until pressures less than 40 cm H(2)O and areflexia are achieved. Sphincter incompetency is diagnosed in incontinent children with pressures less than 40 cm H(2)O and areflexia or stress incontinence. Augmentation is indicated in patients with hydronephrosis or reflux and end-filling pressures or DLPP less than 40 cm H(2)O despite medical management to the point of patient tolerance. A minority of patients, not yet well-defined, will also need augmentation after bladder outlet surgery for similar postoperative indications.

Enuresis, voiding dysfunction and neurogenic bladder in children

This review covers bladder dysfunction in children. A significant amount of work has been done in the past year with regard to enuresis. The International Children Continence Society discussed the issues of bladder dysfunction, including enuresis, and this review covers the findings of that meeting. It also covers the articles that have been published on neurogenic bladder dysfunction as well as on posterior urethral valves.

Management of pediatric neurogenic bladder

Several recent papers have addressed the investigation and management of children with neurogenic bladder. Bladder wall thickness as measured by ultrasound may identify the children with urodynamic risk factors for upper urinary tract deterioration. Strategies such as maximal anticholinergic therapy, total endoscopic management, conservative management throughout puberty, and isolated bladder neck procedures to avoid bladder augmentation show promise. However, at present, there is inadequate long-term follow-up to recommend widespread application of all of these approaches. As children with neurogenic bladder enjoy longer life spans, issues including risks of malignancy related to augmentation and transition to adult-centered care will continue to gain significance.

Pediatric urologists continue to face many challenges in the management of children with neurogenic bladder. This includes identifying predictors of upper urinary tract deterioration, finding efficacious strategies to avoid bladder augmentation, and long-term care. The most recent literature attempts to address these issues. Further prospective studies with adequate follow-up will benefit our understanding of this disease process and help to choose the best strategies to achieve continence and preserve renal function in this population.