Review – Neuro-urologyPediatric Neurogenic Bladder and Bowel Dysfunction: Will My Child Ever Be out of Diapers?
Introduction
Congenital spinal dysraphism accounts for the vast majority of cases of neurogenic bladder and bowel dysfunction in the pediatric population [1]. Rarer etiologies include urologic or anorectal malformations (eg, bladder exstrophy and imperforate anus), as well as acquired injuries from spinal cord/brain trauma or central nervous system tumors. Disruption of sensory and/or motor input to the bladder, urinary sphincter muscles, rectum, and anal sphincter results in urinary and gastrointestinal dysfunction.
Management of neurogenic bladder is critical to the prevention of life-threatening renal failure. The introduction of modern multimodal treatments including both nonsurgical and surgical techniques has resulted in increased life expectancy of patients with spina bifida (SB) [2]. With patients living longer, there is increasing focus on urinary continence. As better quality of life (QoL) research instruments have become available, it is apparent that patients enjoy better lives with successful management of urinary incontinence [3]. Although bowel dysfunction rarely leads to life-threatening complications, constipation and soiling have similar significant consequences on patient well-being. Therefore, it is incumbent on treating physicians to address both urinary and fecal continence, as well as associated issues, such as urinary tract infections (UTIs) and constipation, to maximize patients’ QoL.
Section snippets
Search strategy
A systematic PubMed/Medline search was conducted in August 2019 using Medical Subject Headings (MeSH) terms “neurogenic bladder” and “neurogenic bowel.” Using Boolen techniques, we utilized the following additional MeSH terms: “neurogenic bladder AND sling, suburethral”; “neurogenic bladder AND artificial urinary sphincter”; “neurogenic bladder AND agents, anticholinergic”; “neurogenic bladder AND oxybutynin”; “neurogenic bowel AND fecal incontinence”; “neurogenic bowel AND enema”; “neurogenic
Management of neurogenic bladder
The flow diagram of the neurogenic bladder literature search and results is shown in Figure 1. A total of 49 studies were included in the review: 24 studies for nonsurgical management (Table 1) [5], [6], [7], [8], [9], [10], [11], [12], [13], [14], [15], [16], [17], [18], [19], [20], [21], [22], [23], [24], [25], [26], [27], [28] and 27 studies for surgical management (Table 2) [7], [19], [29], [30], [31], [32], [33], [34], [35], [36], [37], [38], [39], [40], [41], [42], [43], [44], [45], [46],
Conclusions
Approximately half of children born with neurogenic bladder and bowel dysfunction can achieve continence with nonsurgical therapy. The majority of children who cannot attain continence with these measures are able to do so successfully after surgical intervention, but this comes with a high cost of postoperative complications and need for additional procedures. Therefore, agencies such as the International Children’s Continence Society promote a stepwise approach. The entire literature
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