Abstract
Neurogenic bladder in children is a serious dysfunction of lower urinary tract originating due to inborn or acquired disease of spinal cord and spinal nerves. It is a part of multiple defects and belongs to chronic pathological conditions, which is difficult to solve.
The chief aim in the care of children with neurogenic bladder is to prevent infections and deterioration of the function of upper urinary tract as well as to reach urinary and fecal continence at the older age. In order to reach these goals, repeated examinations are required as well as lifelong follow-up and correctly timed therapy.
The basic examinations include, besides ultrasound, urodynamic studies and a clean intermittent catheterization of urinary bladder is the basic therapeutic procedure, if need be supplemented administration of anticholinergics. The recent knowledge of pediatricians and children urologists recommends the first urodynamic examination of patients with inborn defect, which is responsible for development of neurogenic bladder, as early as at the suckling age.
The training of the clean intermittent catheterization is recommended differently, from the newborn to preschool age, but there is a general tendency to start with the catheterization much earlier than the practice was in the seventies to nineties. The early introduction of intermittent catheterization makes it an obvious constituent of everyday routine and it also significantly decreases the need of bladder augmentation at the older age.
Even so a small part of patients which are refractory to conservative treatment the surgery becomes necessary. In most cases in is the augmentation urinary bladder, so called formation of low-pressure and large capacity urinary reservoir or a surgery resulting in improvement of incontinence.
Some interventions, for instance the establishment of continent vesicostomy, may be indicated even to meet the patient's wishes.