Early bladder training in patients with spina bifida

A bladder training programme was applied in 43 children with myelomeningocele and complete urinary incontinence. In one group the training was commenced before the age of 3 years (mean age 1.3 years) and in another group between the ages of 3 and 13 years (mean age 5.8 years). The results as regards continence were better in the group with an early start of training, girls showing significantly better results than boys. Pharmacotherapy and cautious urethral surgery were valuable complements in selected cases. Vesico-ureteral reflux disappeared during treatment in 60% of the patients. Patients not showing significant improvement should be candidates for clean intermittent catheterization and/or cholinergic drugs, if detrusor hyperactivity is present.