Congenital neuropathic bladder: practicalities and possibilities of conservational management

Upper urinary tract and renal deterioration in the child with congenital neuropathy is due to high intravesical pressure associated with urinary retention. Preservation of kidney function often can be achieved when bladder emptying is improved by lowering the urethral resistance, when reflux is cured, and when infection is controlled. Since incontinence is most often of the overflow type, complete bladder evacuation can allow the child to remain dry for a socially acceptable period of time between voidings. Success depends greatly on the child's motivation and on his cooperation in a bladder training regimen. Diversion is sometimes unavoidable but should be considered only when conservational methods have failed.