Electrostimulation of the neuropathic bladder.

Area of Science:

• Pediatric Urology
• Neurology
• Biomedical Engineering

Background:

• Neurogenic bladder is a common complication in children with myelocele, impacting bladder function and leading to potential kidney damage.
• Current management strategies for neurogenic bladder in this population have limitations, necessitating exploration of novel therapeutic approaches.

Purpose of the Study:

• To evaluate the efficacy and safety of intravesical electrostimulation as a treatment modality for neurogenic bladder in pediatric patients with myelocele.
• To assess the impact of repeated electrostimulation courses on intravesical pressure, bladder contractions, and micturition patterns.

Main Methods:

• A prospective study involving 25 children (aged 2 weeks to 13 years) diagnosed with myelocele and neurogenic bladder.
• Patients underwent approximately 500 intravesical electrostimulation treatments over a 2-year period, often in repeated 10-day courses.
• Intravesical pressure, bladder contractions, and clinical improvement were monitored before and after treatment.

Main Results:

• A considerable increase in starting intravesical pressure was observed in all patients following repeated electrostimulation.
• Seventeen out of 25 patients demonstrated significant clinical improvement, characterized by slowly increasing bladder contractions and the emergence of micturition.
• Two patients showed no improvement, and six were not treated long enough for a definitive evaluation.

Conclusions:

• Intravesical electrostimulation is a promising therapeutic option for managing neurogenic bladder in children with myelocele.
• Repeated courses of electrostimulation can lead to objective improvements in bladder physiology, including increased pressure and enhanced detrusor activity.
• While not universally effective, the treatment shows encouraging results, warranting further investigation and optimization for this patient group.