[Neurogenic bladder in children: basic principles in diagnosis and treatment]

Area of Science:

• Urology
• Neuroscience
• Pediatric Surgery

Context:

• Neurogenic bladder diagnosis varies in difficulty, from straightforward in myelomeningocele to challenging in occult spinal dysraphism or other medical conditions.
• Accurate diagnosis and patient follow-up mandate thorough clinical examinations and urodynamic investigations.
• Clinico-anatomical correlations are often poor, complicating management strategies.

Purpose:

• To outline diagnostic challenges and mandatory investigations for neurogenic bladder.
• To detail the primary surgical goal of preserving upper urinary tract function.
• To present a comprehensive overview of treatment strategies for achieving bladder continence and function.

Summary:

• Neurogenic bladder management involves balancing reservoir capacity, compliance, and outlet resistance for ideal micturition.
• Key interventions include intermittent catheterization for bladder emptying and upper tract protection.
• Surgical options for increasing bladder capacity (augmentation cystoplasty) and outlet resistance are diverse, with tissue engineering on the horizon.
• Continent cystostomy and sacral neuromodulation offer solutions for complex cases, while a holistic approach addressing orthopedic, digestive, and sexual issues is crucial for social well-being.

Impact:

• Effective management strategies aim to improve bladder function, prevent upper urinary tract deterioration, and enhance patients' quality of life.
• Multidisciplinary care is essential, integrating urological, orthopedic, and other supportive treatments.
• Advances in surgical techniques and neuromodulation offer promising future directions for neurogenic bladder treatment.