Management of Neurogenic Bladder in Children Following Spinal Injury: A Single-Center Experience

Neurogenic bladder () in children commonly result from spinal injuries or congenital spinal malformations that disrupt sacral and spinal cord neural pathways. Such damage impairs detrusor contraction and sphincter relaxation, causing high intravesical pressures, detrusor-sphincter dyssynergia, vesicoureteral reflux, recurrent urinary tract infections, and incontinence. These dysfunctions can compromise renal function, growth, and quality of life. Clean intermittent catheterization (CIC) remains the gold standard for management, enabling low-pressure voiding, preventing renal deterioration, reducing infections, and promoting independence. This study evaluates the clinical outcomes of CIC in children with spinal injury-induced NB and bowel dysfunction. A retrospective review was conducted using medical records from 2020 to 2025. Twelve children (4 boys, 8 girls) who performed CIC were included. Data collected included etiology, age, catheterization frequency, urinary tract infections, follow-up monitoring, bladder and bowel management, and independence in care. Follow-up included renal, bladder, and ureter ultrasound twice yearly, urinalysis and urine cultures 2-3 times/year, and annual pediatric urology assessment. Four children (2 boys, 2 girls) had congenital spinal malformations including sacral agenesis and lumbar vertebral dysplasia. Eight children presented with paraplegia (2 boys with spinal cord injury, 6 girls: 2 with rupture of arteriovenous malformations, 4 with myelitis). Ages ranged from 22 months to 16 years. All children performed CIC five times daily. Prior to CIC, all children used diapers and had indwelling urinary catheters. CIC was successfully implemented in all children, achieving regular bladder emptying and reducing the need for indwelling catheters. Two children experienced asymptomatic bacteriuria; only one case required prophylactic antibiotics. Urinary leakage between catheterizations was minimal and age-dependent. Urinary leakage between catheterizations, was minimal and if required pads or diapers was age-dependent. Seven children aged ≥12 years managed bladder and bowel care independently. Seven children performed transanal irrigation every other day. Only one child required catheterization support at school due to limited trained nursing staff. No children exhibited upper urinary tract deterioration during follow-up, and all families reported improved autonomy, decreased accidents, and enhanced quality of life. CIC remains the most effective intervention for NB management in children with spinal injury,preventing high intravesical pressures, protecting renal function, and reducing infection rates. Combining CIC with structured bowel management improves continence and independence. Early initiation, individualized schedules, and parental training are critical to optimize clinical outcomes. These findings reinforce current guidelines recommending CIC as first-line therapy for pediatric neurogenic bladder and bowel dysfunction.