Severe bladder dysfunction revealed prenatally or during infancy.

Area of Science:

• Pediatric Urology
• Nephrology
• Congenital Abnormalities

Background:

• Non-neurogenic neurogenic bladder is typically acquired.
• Congenital forms may manifest before toilet training.
• Early diagnosis is crucial for managing upper-tract impairment.

Purpose of the Study:

• To report on congenital non-neurogenic neurogenic bladder diagnosed prenatally or in early infancy.
• To highlight the potential for misdiagnosis in these cases.
• To emphasize the link between antenatal findings and bladder dysfunction.

Main Methods:

• Retrospective review of children with severe bladder dysfunction and upper-tract impairment diagnosed before toilet training.
• Two groups: prenatal diagnosis (n=5) and infancy diagnosis (n=6).
• Analysis of clinical presentation, interventions, and long-term outcomes.

Main Results:

• Prenatal group: Decompensation occurred, requiring clean intermittent catheterization (CIC), bladder augmentation, or sphincteric re-education. Two developed chronic renal failure.
• Infancy group: Presented with vesicoureteral reflux and/or hydro-ureteronephrosis. Three required CIC (Mitrofanoff), three had bladder augmentation. Three developed chronic renal failure, one received a transplant.
• Median follow-up was 14 years (range 0.5-20) and 11 years (range 5-20) respectively.

Conclusions:

• Severe bladder dysfunction can be congenital and initially misdiagnosed.
• Upper-tract dilatation and secondary renal impairment are common.
• Antenatal diagnosis of bilateral pyeloureteral dilatation may indicate early bladder dysfunction.