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 highest priority and depends significantly on the dynamics of the bladder and bladder outlet. Bladder management is an effort to achieve “social continence” by having or producing a bladder capable of hold urine and able to be emptied at intervals by catheterization. Initially, this consists of catheterization and with or without medications which relax bladder contractility and with or without antibiotic prophylaxis. This typically begins between the ages of 3-5 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 become 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 are performed in the Georgia Pediatric Urology main office. This study assesses the anatomy as well as the function of the bladder and bladder outlet with X-rays and pressure measurements of bladder and abdomen. Placement of two small catheters into the bladder and rectum are facilitated with the use of 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 or sedation undergo videourodynamic studies at Egleston Children’s Hospital.