Related Experiment Video
Updated: Dec 30, 2025
Detrusor Underactivity Model in Rats by Conus Medullaris Transection
Published on: August 28, 2020
Pediatric Neurogenic Bladder and Bowel Dysfunction: Will My Child Ever Be out of Diapers?
Ashley W Johnston1, John S Wiener1, J Todd Purves1
1Department of Surgery, Division of Urology, Duke Medical Center, Durham, NC, USA.
Insights
Children with neurogenic bladder and bowel dysfunction have a 50% chance of urinary continence and 75% chance of fecal continence. Surgical options exist but carry high complication risks, making non-surgical methods preferable first-line treatments.
Area of Science:
- Pediatric Urology
- Neurogenic Bladder and Bowel Dysfunction
- Continence Management
Background:
- Managing patient and parent expectations for urinary and fecal continence is crucial for congenital conditions causing neurogenic bladder and bowel dysfunction.
- Physicians require knowledge of treatment algorithms and expected outcomes for effective patient counseling.
Purpose of the Study:
- To systematically evaluate the evidence on the utilization and success rates of various continence management modalities in children with neurogenic bladder and bowel dysfunction.
- To assess related outcomes associated with different treatment approaches.
Main Methods:
- A systematic literature review was conducted using PubMed/Medline in August 2019.
- Analysis included 114 publications: 49 focused on bladder management and 65 on bowel management.
Main Results:
- Children with neurogenic bladder achieved urinary continence in 50% of cases (44% non-surgical, 64% surgical).
- Patients with neurogenic bowel achieved fecal continence in 75% of cases (78% non-surgical, 73% surgical).
- High rates of surgical complications and revisions were noted in both bladder and bowel management categories.
Conclusions:
- Approximately 50% of children with neurogenic bladder dysfunction achieve urinary continence, and about 75% with neurogenic bowel dysfunction achieve fecal continence.
- Surgical interventions can be effective for refractory cases but are associated with significant complication and revision rates, supporting their role as second-line therapy.
- Findings align with International Children's Continence Society guidelines, emphasizing conservative management first.
Context:
Managing patient and parent expectations regarding urinary and fecal continence is important with congenital conditions that produce neurogenic bladder and bowel dysfunction. Physicians need to be aware of common treatment algorithms and expected outcomes to best counsel these families.
Objective:
To systematically evaluate evidence regarding the utilization and success of various modalities in achieving continence, as well as related outcomes, in children with neurogenic bladder and bowel dysfunction.
Evidence Acquisition:
We performed a systematic review of the literature in PubMed/Medline in August 2019. A total of 114 publications were included in the analysis, including 49 for bladder management and 65 for bowel management.
Evidence Synthesis:
Children with neurogenic bladder conditions achieved urinary continence 50% of the time, including 44% of children treated with nonsurgical methods and 64% with surgical interventions. Patients with neurogenic bowel problems achieved fecal continence 75% of the time, including 78% of patients treated with nonsurgical methods and 73% with surgical treatment. Surgical complications and need for revisions were high in both categories.
Conclusions:
Approximately half of children with neurogenic bladder dysfunction will achieve urinary continence and about three-quarters of children with neurogenic bowel dysfunction will become fecally continent. Surgical intervention can be successful in patients refractory to nonsurgical management, but the high complication and revision rates support their use as second-line therapy. This is consistent with guidelines issued by the International Children's Continence Society.
Patient Summary:
Approximately half of children with neurogenic bladder dysfunction will achieve urinary continence, and about three-quarters of children with neurogenic bowel dysfunction will become fecally continent. Most children can be managed without surgery. Patients who do not achieve continence with nonsurgical methods frequently have success with operative procedures, but complications and requirements for additional procedures must be expected.
Related Concept Videos
01:26The Micturition Reflex
The process begins with bladder filling, where the bladder wall stretches as urine accumulates. This stretching activates the urine storage reflex, mediated by the sacral spinal segments and the pontine storage center. Efferent sympathetic impulses stimulate the detrusor muscle to relax and the internal urethral sphincter to contract, facilitating...
01:20Disorders of the Urinary System
Urinary tract infections (UTIs) are one of the most common urinary system disorders. They are caused by bacteria that enter the urethra and can spread to the bladder resulting in cystitis. Pyelonephritis is the result of a UTI that has ascended to the level of the...
01:26Nursing Assessment of the Genitourinary System II: Inspection and Palpation
01:17Urinary Tract Infection IV: Nursing Management
01:26Psychosexual Stages of Personality: Anal
01:23Pharmacokinetics in Pediatric Patients: Overview and Drug Absorption