Neurogenic bladder (NGB) refers to abnormal bladder function due to a neurological problem. In children, this is most commonly seen due to spina bifida. There are also many other spinal cord problems in children that can lead to the development of NGB, including tethered cord, lipomeningocele, syrinx, etc. Unfortunately, the type of neurological problem or spinal cord level is rarely helpful in predicting the degree or type of bladder function problems that will be found. These bladder problems can include failure to store urine at safe/low pressure, failure to empty with voiding, reflux of urine back up into the kidney(s), spasticity of the bladder (unwanted contractions of the bladder at random times) and incontinence of urine. Untreated NGB can lead to various serious problems, including kidney damage, incontinence, recurrent urinary tract infections and bladder stones.
Therefore, we focus our evaluation and treatment of children with NGB on an individualized assessment of each child’s specific bladder function. The mainstay of these evaluations, in addition to a history and physical exam, includes regular kidney/bladder ultrasounds and periodic urodynamic testing. Urodynamic testing involves placing small catheters into the bladder and rectum to measure as much as possible about bladder function, including volume the bladder holds, pressure inside the bladder during filling, evaluation of voiding (peeing) and spasticity (abnormal contractions during slow filling). Urodynamics can be scary and uncomfortable for some children who are not already accustomed to regular catheterization. We perform these tests every day in our office, with experienced staff and nurses who are well aware of the anxieties and concerns children have with such an exam. Our urodynamic suite is “kid-friendly,” including a DVD player and selection of children’s movies. Most children tell us, “that wasn’t as bad as I thought,” when the exam is complete! Rest assured, we will do everything possible to alleviate stress and anxiety if urodynamics is needed for your child’s assessment.
Because each child with NGB has different and individual bladder function problems, social/family situations or other medical conditions, we tailor the treatment of children with NGB individually. Your physician will review the findings of the evaluations and then discuss treatment options.
Our goals for the treatment of children with NGB involves a three-tiered overall approach:
- Ensure bladder function is safe to prevent kidney damage.
- Minimize or eliminate urinary tract infections.
- Help children and families motivated to achieve continence do so. In some cases, surgery will be required to reach these goals. If this is the case, please know that as fellowship-trained pediatric urologists, we have extensive experience with the full spectrum of procedures that can be needed, including continent catheterizable channels (appendicovesicostomy/Mitrofanoff/Monti), bladder augmentation, incontinent ileovesicostomy (ileal chimney), cutaneous vesicostomy, bladder neck sling and/or repair, and bladder neck closure.