Neurogenic Bladder

What is a neurogenic bladder?

The bladder has two main functions: To store urine and then to empty urine when it is full. For this process to be successful, the nerves and the muscles of the urinary tract must work together. Nerves carry messages from the bladder to the brain and from the brain to the muscles of the bladder and sphincter (the “hold on” muscle between the bladder and the urethra). These messages tell the bladder muscle to relax or contract. In a neurogenic bladder, the nerves that are supposed to carry these messages do not work properly so the bladder is not able to store or empty urine effectively.

Causes

In children a neurogenic bladder may be related to a birth defect or it may be acquired as the result of a different problem. The following are some of the most common causes of neurogenic bladder:

  • Spina bifida
  • Spinal cord trauma
  • Central nervous system tumors
  • Pelvic tumors

Symptoms

Symptoms of neurogenic bladder may vary depending upon the cause and other associated conditions. In many cases, neurogenic bladder is associated with the following:

Evaluation and diagnosis

Your child may undergo a variety of tests to help us confirm the diagnosis and learn the extent of the condition.

  • Video urodynamic study: This study evaluates how well your child’s bladder fills and empties.
  • Renal and bladder ultrasound
  • Voiding cystourethrogram
  • MRI of the spine
  • Blood work to assess kidney function

Treatment

The Division of Urology specializes in the care of children with neurogenic bladder. Each year we treat more than 300 children with this condition, most commonly through our Neurogenic Bladder Program.

Our goals in treating children with a neurogenic bladder are to preserve renal function, achieve social continence and promote a positive self-esteem as the children get older. Our team of physicians, nurses and psychologists will work closely with your family to ensure your goals are met.

Medical management

  • Clean intermittent catheterization (CIC): CIC is a clean, but not sterile, procedure taught to parents and families by our trained nursing staff. By routinely empting the bladder, it decreases the risk of UTIs, prevents hydronephrosis, protects the bladder and achieves continence.
  • Overnight catheter drainage: Some children require leaving a catheter in their bladder while they sleep to continuously drain the urine overnight. This can reduce the frequency of UTIs, improves kidney dilatation and improves continence. Overnight drainage in conjunction with daytime clean intermittent catheterization may maintain the bladder’s storage properties and avoid surgery.
  • Prophylactic antibiotic therapy: If there are concerns of inability to empty the bladder, vesicoureteral reflux (VUR) or other conditions that will put your child at a higher risk of developing a urinary tract infection, a once-per-day low dose of antibiotics may be recommended.
  • Anticholinergic medications: This class of medications (Ditropan, Detrol) helps to relax the smooth muscles of the bladder, prevent bladder contractions and increase bladder capacity.

Surgical management

Surgery may be appropriate for patients whose incontinence cannot be controlled through medical measures.

  • Vesicostomy: A vesicostomy is an opening in the lower abdomen into the bladder which allows urine to continuously drain. The opening is created by a surgical procedure where a small incision is made through the skin and into the bladder. A small part of the bladder wall is turned inside out and sewn to the abdomen. It appears as a small slit, surrounded by pink tissue. The vesicostomy is a temporary option and can be reversed in the future.
  • Bladder augmentation: Augmentation of the bladder increases the capacity and decreases the pressure of the bladder by using segments of bowel as a patch.
  • Appendicovesicostomy (Mitrofanoff): CHOP’s Division of Urology was the first pediatric urology program in North America to embrace the use of a catheterizable channel constructed out of the appendix. In an appendicovesicostomy, a continent stoma (opening) is created to provide easy access to empty the bladder. This segment may be used with the appendix or a portion of the bowel that connects the bladder to the surface of the skin. This technique makes it possible for children and adolescents to pass a catheter through the stoma to empty their bladder, 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.
  • MACE (Malone antegrade colonic enema): A MACE procedure allows children with incontinence of stool to deliver an enema directly into the colon, to empty it of stool, versus the rectum. A continent stoma (opening) can be created with either the appendix or portion of the bowel that connects to the surface of the skin.
  • Cecostomy button: A cecostomy button is a small plastic tube that is placed into the colon through the abdomen. Like the MACE procedure, it allows children with stool incontinence to deliver fluid directly to the colon to empty it of stool.

Reviewed by: Division of Urology

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