Neurogenic bladder in children: basic principles, new therapeutic trends.

Area of Science:

• Pediatric Urology
• Neuro-Urology

Background:

• Neurogenic bladder diagnosis is clear in myelomeningocele but challenging in occult dysraphism or CNS disorders due to poor clinico-anatomical correlations.
• Urinary leak may be an initial symptom, but preserving upper urinary tract function is the paramount objective for pediatric surgeons.

Purpose of the Study:

• To outline diagnostic and management strategies for neurogenic bladder in children.
• To emphasize the importance of preserving upper urinary tract function and achieving complete bladder emptying.
• To discuss various medical and surgical treatment options for neurogenic bladder.

Main Methods:

• Clinical examination and urodynamic exploration are essential for diagnosis and follow-up.
• Treatment involves a combination of medical therapies (e.g., anticholinergic drugs, botulinum toxin) and surgical procedures.
• Techniques include intermittent bladder catheterization, augmentation cystoplasty, bladder neck reconstruction, artificial urinary sphincter, and continent cystostomy.

Main Results:

• Complete bladder evacuation, adequate capacity, compliance, and appropriate sphincter outlet resistance are key to protecting the upper urinary tract.
• Intermittent catheterization is often necessary for complete bladder emptying.
• Various surgical and medical options exist to increase bladder capacity and outlet resistance, tailored to patient specifics.

Conclusions:

• Effective neurogenic bladder management requires balancing bladder functions through combined medical and surgical approaches.
• Total endoscopic management is a promising first-line approach.
• Holistic management considering orthopedic, digestive, and sexual health is crucial for an acceptable quality of life.