[Clinical studies on children with congenital neurogenic bladder treated during the past 10 years]

During the past 10 years, 22 children (13 males and 9 females) had been treated for congenital neurogenic bladder at our department. These cases were reviewed for urinary tract infection, urodynamics, vesicoureteral reflux and renal deterioration. Urinary tract infections were observed during the follow-up period in 12 of the 22 cases (54.6%). The incidence was 38.5% in males and 88.9% in females. Cystometric findings were arbitrarily divided into 3 types; hyperreflexic type, areflexic hypertonic type and areflexic hypotonic type. Of the 17 cases examined, 3 cases were of the hyperreflexic type, 6 cases the areflexic hypertonic type and 8 cases the areflexic hypotonic type. Urinary tract infections were not observed in 5 of the 8 cases categorized as the areflexic hypotonic type compared to one of the 9 cases of the hyperreflexic and areflexic hypertonic types together. UPP was examined in 13 cases. UP max values were lower than normal in the areflexic type cases, but were normal or higher in the hyperreflexic type cases. Vesicoureteral reflux was examined in 9 cases. Reflux was observed in 9 ureters of 6 patients. Renal deterioration was observed in 6 cases; 4 cases of hydronephrosis and 2 cases of pyelonephritis. Management of 22 cases consisted of ileal conduit (1 case), clean intermittent self-catheterization (2 cases) and Cred é maneuver and/or pharmacologic treatments (19 cases). The usefulness of clean intermittent self-catheterization and management for vesicoureteral reflux were discussed centering on 4 selected cases.