The guidelines on management of neurogenic bladder in children and adolescents were released in November 2019 by the European Association of Urology and the European Society for Pediatric Urology.
In newborns with spina bifida, clean intermittent catheterization (CIC) should be started as soon as possible after birth.
In those with intrauterine closure of the defect, urodynamic studies should be performed before the patient leaves the hospital.
In those with closure after birth, urodynamics should be done within the next 3 months.
Anticholinergic medication (oxybutynin is the only well-investigated drug in this age group—dosage 0.2-0.4 mg/kg/day) should be administered if the urodynamic study confirmed detrusor overactivity.
Close follow-up—including ultrasound, bladder diary, urinalysis, and urodynamics—is necessary in the first 6 years. After that time the frequency of follow-up can be reduced, depending on the individual risk and clinical course.
In all other children with the suspicion of a neurogenic bladder (eg, due to tethered cord, inflammation, tumors, trauma, or other reasons), as well as those with anorectal malformations, urodynamics—preferably video-urodynamics—should be carried out as soon as suspicion of a neurogenic bladder arises, and conservative treatment should be started soon after confirmation of the diagnosis of neurogenic bladder.
With conservative treatment, the upper urinary tract is preserved in up to 90% of patients; urinary tract infections are common but not severe, complications of CIC are quite rare, and continence can be achieved at adolescence in up to 80% without further treatment.
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Cite this: Pediatric Neurogenic Bladder Clinical Practice Guidelines (2019) - Medscape - Dec 03, 2019.