Bladder Dysfunction Guidelines

Updated: Jan 09, 2020
  • Author: Gregory T Carter, MD, MS; Chief Editor: Elizabeth A Moberg-Wolff, MD  more...
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Guidelines

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