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Early bladder training in patients with spina bifida
Insights
Early bladder training significantly improves continence in children with myelomeningocele. Starting before age 3 yields better results, especially for girls, with medication and surgery offering supplementary benefits.
Area of Science:
- Pediatric Urology
- Neurogenic Bladder Management
- Spina Bifida Research
Background:
- Myelomeningocele frequently causes complete urinary incontinence in children.
- Effective management strategies are crucial for improving quality of life and preventing complications.
Purpose of the Study:
- To evaluate the efficacy of a bladder training program in children with myelomeningocele and urinary incontinence.
- To compare outcomes based on the age at which bladder training commenced.
Main Methods:
- A bladder training program was implemented in 43 children with myelomeningocele.
- Participants were divided into two groups: early start (before age 3) and later start (ages 3-13).
- Pharmacotherapy, urethral surgery, and clean intermittent catheterization were considered as adjuncts.
Main Results:
- Children who began bladder training before age 3 demonstrated superior continence outcomes.
- Girls achieved significantly better results compared to boys.
- Vesico-ureteral reflux resolved in 60% of patients during treatment.
Conclusions:
- Early initiation of bladder training is associated with improved continence in pediatric myelomeningocele patients.
- Bladder training, complemented by pharmacotherapy and surgery, offers a viable treatment approach.
- Clean intermittent catheterization and/or cholinergic drugs are recommended for managing persistent detrusor hyperactivity.
Abstract:
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.