Neurogenic Bladder
The bladder has two main functions: to store urine and then to empty it when it is full. For this process to be possible, the nerves and muscles of the urinary tract must work together. In a neurogenic bladder, the nerves that must carry messages from the bladder to the brain and from the brain to the bladder and sphincter muscles do not function properly, so the bladder cannot store or empty urine effectively.
Causes
- Spina bifida: myelomeningocele, lipomeningocele,
- Spinal cord trauma
- Anorectal malformations
- Cerebral palsy
- Tumors of the nervous system and pelvic tumors.
Neurogenic bladder is associated with the following symptoms:
- Urinary incontinence
- Urinary retention
- Hydronephrosis or dilatation of the urinary tract.
- Vesicoureteral reflux.
- Urinary tract infection.
- Renal calculi
Evaluation and complementary studies:
Your child may undergo a variety of tests to help us confirm the diagnosis and learn the extent of the disease:
- Renal and bladder ultrasound.
- Magnetic resonance imaging of the spine.
- Voiding cystourethrography.
- Urodynamics.
- VideoUrodynamics.
- Renal scintigraphy.
- Blood and urine tests to evaluate renal function.
Treatment
The main goals are to preserve renal function, achieve social continence, and promote positive self-esteem as children grow older.
Clean intermittent catheterization: is a clean, but not sterile, procedure taught to parents and families by our trained nursing staff. By routinely emptying the bladder, it decreases the risk of urinary tract infections, prevents dilation of the urinary tract, protects the bladder and achieves urinary continence.
Anticholinergic medications: this class of medications, such as oxybutynin, helps to relax the smooth muscles of the bladder, prevents bladder muscle contractions, generating increased capacity with low pressures.
Selective medications: Solifenacin, Darifenacin and Mirabegron.
Endoscopic treatments: Botulinum neurotoxin injections in detrusor, bulking agents in vesicoureteral reflux.
Surgical treatment options: In case the previous medical treatment is insufficient, our center is trained with professionals who perform procedures such as: bladder enlargement, canals for bladder catheterization. As well as creation of aponeurotic slings and placement of artificial urinary sphincter for children and adolescents with urinary incontinence.