The care of children with a neurogenic bladder is one of our longstanding specialties. Spina bifida is the most common cause of a neurogenic bladder in children. Early management of patients with spina bifida is critical in order to reduce the chances they will need one or more surgeries. We have providers who specialize in all aspects of medical and surgical care for patients with spina bifida, including continent reconstruction, management of stone disease, catheterization and coping with chronic medical conditions.
Our spina bifida program is one of the largest in the country. In the Division of Urology alone we follow more than 300 different children who have a neurogenic bladder.
New babies with a neurogenic bladder due to spina bifida will be studied closely after birth to determine what types of intervention might be necessary. Over the first year of life, we will see your child several times to ensure the bladder and kidneys remain healthy and to develop an ongoing urinary management plan.
Once the plan is established, we will see your child on at least an annual basis. Of course, we will see your child more often if things like urinary tract infections or kidney or bladder stones become issues, or if you should have any questions or concerns. Our initial plan usually involves some combination of bowel management, catheterization and the use of medication to help the bladder store urine effectively.
Surgery may be appropriate for those patients whose incontinence cannot be controlled through medical measures. CHOP Urology was the first pediatric urology program in North America to embrace the notion of a catheterizable channel constructed out of appendix. Known as an appendicovesicostomy, the procedure was initially performed 25 years ago.
This technique has made it possible for many children and adolescents to perform their own catheterizations, giving them age-appropriate independence. This procedure is generally combined with additional surgical procedures to increase the capacity of the bladder and, many times, with procedures that decrease the chances of urinary leakage via the urethra.
Some patients benefit from the creation of a catheterizable channel leading to the colon. This channel, known as an antegrade enema, helps children better empty their colon so they will not leak stool. In conjunction with our spina bifida team, we will help families assess whether this is a good option.
Our surgeons, a dedicated nurse practitioner, nurses who specialize in catheterization and a psychologist who specializes in working with children who have chronic conditions, will work with you and your child.