Bladder Dysfunction Guidelines: Guidelines Summary

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Guidelines Summary

In 2019, the European Association of Urology/European Society for Paediatric Urology guidelines on neurogenic bladder management in children and adolescents were updated. With regard to diagnostics and conservative management, the update included the following recommendations^[36]:

Clean intermittent catheterization (CIC) should commence as soon as possible postnatally in a newborn with spina bifida
It is recommended that urodynamic studies be carried out prior to hospital discharge in newborns with spina bifida who underwent intrauterine defect closure
In newborns with spina bifida whose defect underwent postnatal closure, urodynamics should be performed within a 3-month period
If detrusor overactivity has been confirmed through urodynamic evaluation, newborns with spina bifida should undergo treatment with anticholinergic medication (although oxybutynin is the only such drug that has been well-studied in this age group; dosage of 0.2-0.4 mg/kg weight per day); the patients should be closely followed up by means that include ultrasonography, a bladder diary, urinalysis, and urodynamics, within the first 6 years, with prolonged time intervals for evaluation, depending on individual risk and clinical course, possible after that
In all other children, urodynamic (preferably video urodynamic) evaluation should be performed immediately after neurogenic bladder is suspected in association with such causes as tethered cord, inflammation, tumors, or trauma, or when an anorectal malformation is present; conservative treatment should commence soon after neurogenic bladder has been diagnosed

With regard to surgical management, the update included the following guidelines^[37]:

In order to preserve upper and lower urinary tract function, patients may require such surgical interventions as botulinum toxin A injections into the detrusor muscle, bladder augmentation, and urinary diversion
If performance of transurethral CIC presents difficulties, the patient should be given the option of undergoing creation of a continent catheterizable channel, although consideration should be given to the fact that the revision rate is as high as 50%
Persistent bladder outlet weakness requires surgery to provide higher resistance/obstruction at the level of the bladder outlet; the success rate is as high as 80%; an option for some patients involves closure of the bladder neck and creation of a continent catheterizable stoma

Medication

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Media Gallery

Pons is major relay center between brain and bladder. Mechanical process of urination is coordinated by pons in area known as pontine micturition center (PMC).
Large stellate urinary bladder stone. Image courtesy of Wikimedia Commons.

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Author

Gregory T Carter, MD, MS Medical Director, St Luke’s Rehabilitation Institute, Spokane, WA

Gregory T Carter, MD, MS is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, Association of Academic Physiatrists

Disclosure: Nothing to disclose.

Chief Editor

Elizabeth A Moberg-Wolff, MD Medical Director, Pediatric Rehabilitation Medicine Associates

Elizabeth A Moberg-Wolff, MD is a member of the following medical societies: American Academy for Cerebral Palsy and Developmental Medicine, American Academy of Physical Medicine and Rehabilitation

Disclosure: Nothing to disclose.

Acknowledgements

Andrew C Krouskop, MD Assistant Professor and Chair, Department of Orthopedics, Division of Physical Medicine and Rehabilitation, University of Tennessee College of Medicine at Chattanooga

Disclosure: Nothing to disclose.

Ramon S Lansang Jr, MD Consulting Staff, Department of Orthopedics, Charleston Area Medical Center

Ramon S Lansang Jr, MD is a member of the following medical societies: American Academy of Pediatrics, American Academy of Physical Medicine and Rehabilitation, and American Medical Association

Disclosure: Nothing to disclose.

Teresa L Massagli, MD Professor of Rehabilitation Medicine and Pediatrics, University of Washington School of Medicine

Teresa L Massagli, MD is a member of the following medical societies: American Academy of Pediatrics, American Academy of Physical Medicine and Rehabilitation, and Association of Academic Physiatrists

Disclosure: Nothing to disclose.

Richard Salcido, MD Chairman, Erdman Professor of Rehabilitation, Department of Physical Medicine and Rehabilitation, University of Pennsylvania School of Medicine

Richard Salcido, MD is a member of the following medical societies: American Academy of Pain Medicine, American Academy of Physical Medicine and Rehabilitation, American College of Physician Executives, American Medical Association, and American Paraplegia Society

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Reference Salary Employment

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