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The nonneurogenic neurogenic bladder of early infancy
V R Jayanthi1, A E Khoury, G A McLorie
1Section of Pediatric Urology, Ohio State University, Columbus, USA.
Insights
Congenital dysfunctional voiding can cause nonneurogenic neurogenic bladder in infants, a severe condition previously thought to affect older children. Early diagnosis and management are crucial for affected newborns.
Area of Science:
- Pediatric Urology
- Neonatal Medicine
- Voiding Dysfunction
Background:
- Nonneurogenic neurogenic bladder (NNB) is typically diagnosed in older children.
- Congenital dysfunctional voiding (CDV) is an underrecognized cause of NNB in neonates.
Observation:
- Evaluated 7 infants (newborn-30 months) with NNB, no neurological/anatomical obstruction.
- Presentations included prenatal hydronephrosis, urosepsis, and failure to thrive.
- Radiology/urodynamics showed poorly compliant bladders, incomplete emptying, and upper tract pathology.
Findings:
- All patients had significant upper tract issues (azotemia, reflux, hydroureteronephrosis).
- Initial treatment with cutaneous vesicostomy improved 3 patients; 3 required bladder augmentation.
- One patient needed intermittent catheterization despite improved storage function.
Implications:
- NNB can manifest in the neonatal period due to CDV.
- This severe voiding disorder requires prompt recognition and management.
- Early intervention can prevent severe renal damage and improve bladder function.
Purpose:
The nonneurogenic neurogenic bladder has traditionally been believed to represent a disorder of older children. We report on patients in whom congenital dysfunctional voiding may be the underlying cause of nonneurogenic neurogenic bladder in early infancy.
Materials And Methods:
We evaluated 5 male and 2 female patients newborn to 30 months old with dysfunctional neurogenic bladder and no evidence of neurological pathology or anatomical outflow obstruction. Presentation included prenatal hydronephrosis in 3 cases, urosepsis in 2 and failure to thrive in 2. Radiological and urodynamic investigations revealed thick walled, poorly compliant bladders in 5 patients and incomplete bladder emptying bordering on urinary retention in 2. There was significant upper tract pathology in all cases, including azotemia in 4, reflux in 4 and hydroureteronephrosis in 6. Due to poor bladder function, manifested by incomplete emptying or high storage pressures, all patients were initially treated with cutaneous vesicostomy.
Results:
Bladder appearance and function subsequently improved in 3 patients and vesicostomy was reversed. Three patients with persistently thickened bladders, including 2 with renal failure, underwent bladder augmentation. The remaining patient had improved bladder storage function but requires intermittent catheterization.
Conclusions:
The nonneurogenic neurogenic bladder represents a rare, severe form of dysfunctional voiding that may be present even in the neonatal period.