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Current management of childhood neuropathic bladder: review of 156 cases
1Urology Department, Royal Liverpool Childrens Hospital, Great Britain.
Insights
This study on neuropathic bladder management in children shows that most achieve continence with treatment. Advances in management aim to preserve kidney function and enable appliance-free continence.
Area of Science:
- Pediatric Urology
- Nephrology
- Reconstructive Urology
Background:
- Neuropathic bladder management focuses on preserving renal function and achieving continence.
- Recent advancements suggest these goals are increasingly attainable.
- A comprehensive management scheme is crucial for pediatric patients.
Purpose of the Study:
- To outline a management scheme for neuropathic bladder in children.
- To assess the effectiveness of the scheme in maintaining renal function and achieving continence.
- To evaluate outcomes based on patient disability and treatment approach.
Main Methods:
- Video-urodynamic assessment was used for preliminary evaluation.
- 156 children with neuropathic bladder were treated between 1984-1988.
- Management strategies included non-surgical, surgical, penile appliances, urethral catheters, and urinary diversion.
Main Results:
- 5% of cases showed upper renal tract deterioration; 68% improved in cases with pre-existing dilatation.
- Appliance-free continence was the goal for 75% of patients.
- Continence was achieved in 78% of non-surgically managed and 86% of surgically managed patients, with an overall 80% success rate.
Conclusions:
- The outlined management scheme is effective in treating neuropathic bladder in children.
- Maintaining renal function and achieving appliance-free continence are attainable goals.
- Tailored management strategies are necessary for disabled patients, while most ambulant children can achieve continence.
Abstract:
Management of neuropathic bladder aims to maintain renal function and to secure appliance-free continence; because of recent advances, both objectives are theoretically attainable. Our present scheme of management, based upon preliminary video-urodynamic assessment, is outlined. In the years 1984-1988 we treated 156 children suffering from neuropathic bladder. In 5 per cent of cases the upper renal tracts have deteriorated on treatment; in patients presenting with upper tract dilatation, improvement has been obtained in 68 per cent. A quarter of the patients were considered too generally disabled to achieve appliance-free continence; these have been managed by penile appliance, indwelling urethral catheter or, occasionally, urinary diversion. For three-quarters of the patients, most ambulant, appliance-free continence was the goal; 68 per cent have been managed nonsurgically and 32 per cent surgically. Reliable day-time continence has been achieved in 78 per cent of the former and 86 per cent of the latter, 80 per cent overall.