Pediatric Neurogenic Bladder

Specialized Care for Children’s Bladder Health

A neurogenic bladder is caused by an abnormal innervation of the bladder secondary to congenital spinal cord abnormalities, spinal cord injury, or injury to nerves during pelvic surgery. The most common cause of a neurogenic bladder in childhood is spina bifida.

Appropriate bladder innervation is paramount for normal bladder and bladder outlet (sphincter) function and allows normal storage and emptying of urine. Abnormal storage and emptying of urine leads to urinary incontinence, urinary tract infections, and occasionally — but most importantly — deteriorating kidney function. Early kidney ultrasound and a videourodynamic study at 3 months of age are necessary to assess the need for clean intermittent catheterization and pharmacologic therapy.

Assessment and preservation of renal function are of the highest priority and depend significantly on the bladder and bladder outlet dynamics.

Bladder management is an effort to achieve “social continence” by having or producing a bladder capable of holding urine and able to be emptied at intervals by catheterization. Initially, this consists of catheterization with or without medications that relax bladder contractility and with or without antibiotic prophylaxis.

This typically begins between the ages of 3 and 5 years. When these conservative or non-surgical treatments fail, and/or kidney function deteriorates, a bladder augmentation with a catheterizable channel (Mitrofanoff) and possible bladder neck sling becomes necessary.

In some cases of severe constipation, a catheterizable channel to the colon for Malone’s antegrade colonic enemas (MACE) is created in the same setting.

Videourodynamic Studies

Videourodynamic studies are performed at our Sandy Springs location. This study assesses the anatomy and function of the bladder and bladder outlet with X-rays and pressure measurements of the bladder and abdomen.

Placement of two small catheters into the bladder and rectum is facilitated using a local anesthetic gel. A DVD player is available, and children are encouraged to bring their favorite movie, toy, or blanket.

Children who require catheter placement by cystoscopy may be scheduled at both Egleston (soon to be Arthur Blank) or Scottish Rite Hospital. Children who require VUDS with sedation will be scheduled at Scottish Rite Hospital.