Surgical evaluation and management of neurogenic bowel and bladder in children with spinal dysraphism

Neurogenic bowel and bladder are common comorbidities found in children with spinal dysraphism. Although historically managed reactively, treatment focus has shifted toward proactive surgical and medical management aimed to preserve renal function and achieve social continence. This review evaluates recent evidence in the evaluation and surgical management of these conditions, emphasizing a multidisciplinary approach to ensure long-term independence for pediatric patients with spinal dysraphism.

Recent guidelines suggest delaying initial renal imaging until 48 h postbirth for accuracy. Newer evidence also indicates that ultrasound alone is insufficient for monitoring renal health, requiring supplemental markers like cystatin C. Bladder management continues to evolve with the success of awake outpatient botulinum toxin-A injections. Surgical options including robotic-assisted and single-incision laparoscopic techniques for continent bowel and bladder channels demonstrate high success rates, with multiinstitutional data specifically highlighting high family satisfaction with the Malone Antegrade Continence Enema (MACE).

Proactive management is essential for optimizing long-term outcomes for children with spinal dysraphism. While surgical advancements improve recovery and continence, high rates of nonadherence to catheterization and bowel management protocols remain a challenge. Successful management requires balancing innovative surgical techniques with patient preferences and longitudinal support to ensure lifelong health and independence.