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International Children's Continence Society's recommendations for therapeutic intervention in congenital neuropathic
Y F Rawashdeh1, P Austin, C Siggaard
1Pediatric Urology, Aarhus University Hospital, Denmark.
Insights
This consensus offers guidance on treating congenital neuropathic bladder and bowel dysfunction in children, prioritizing non-surgical interventions before considering surgery for improved continence outcomes.
Area of Science:
- Pediatric Urology
- Gastroenterology
- Neurology
Background:
- Congenital neuropathic bladder and bowel dysfunction significantly impacts children's quality of life.
- Effective management requires a multidisciplinary approach integrating urological and gastrointestinal perspectives.
Purpose of the Study:
- To establish a consensus view on therapeutic interventions for congenital neuropathic bladder and bowel dysfunction in children.
- To provide evidence-based and expert-opinion guidance for clinicians managing these complex conditions.
Main Methods:
- Consensus development through discussions among pediatric urologists and gastroenterologists.
- Draft review document shared with International Children's Continence Society (ICCS) members for feedback.
- Incorporation of relevant research and expert opinion, not a systematic literature review.
Main Results:
- Detailed guidelines on pharmacological and surgical interventions for bladder and bowel dysfunction.
- Emphasis on non-surgical approaches (pharmacological agents, medical devices, neuromodulation) prior to surgery.
- Specific treatments discussed include anticholinergics, botulinum-A toxin, neuromodulation techniques, and various surgical options tailored to individual needs.
Conclusions:
- Non-surgical interventions are recommended as the primary treatment modality.
- Surgical interventions should be individualized based on urodynamic findings, patient history, and co-morbidities.
- Comprehensive management strategies are crucial for optimizing outcomes in pediatric neuropathic bladder and bowel dysfunction.
Purpose:
We present a consensus view of members of the International Children's Continence Society on the therapeutic intervention in congenital neuropatic bladder and bowel dysfunction in children.
Material And Methods:
Discussions were held by a group of pediatric urologists and gastroenterologists appointed by the board. The following draft review document was open to all the ICCS members via the ICCS web site. Feedback was considered by the core authors and by agreement, amendments were made as necessary. The final document is not a systematic literature review. It includes relevant research when available as well as expert opinion on the current understanding of therapeutic intervention in congenital neuropatic bladder and bowel dysfunction in children.
Results:
Guidelines on pharmalogical and surgical intervention are presented. First the multiple modalities for intervention that do not involve surgical reconstruction are summarized concerning pharmacological agents, medical devices, and neuromodulation. The non-surgical intervention is promoted before undertaking major surgery. Indicators for non-surgical treatments depend on issues related to intravesical pressure, upper urinary tract status, prevalence of urinary tract infections, and the degree of incontinence. The optimal age for treatment of incontinence is also addressed. This is followed by a survey of specific treatments such as anticholinergics, botulinum-A toxin, antibiotics, and catheters. Neuromodulation of the bladder via intravesical electrical stimulation, sacral nerve stimulation, transcutaneous stimulation, and biofeedback is scrutinized. Then follows surgical intervention, which should be tailored to each individual, based on careful consideration of urodynamic findings, medical history, age, and presence of other disability. Treatments mentioned are: urethral dilation, vesicostomy, bladder, augmentation, fascial sling, artificial urinary sphincters, and bladder neck reconstruction and are summarized with regards to success rates and complications. Finally, the treatment on neuropathic bowel dysfunction with rectal suppositories irrigation and transrectal stimulation are scrutinized.
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