Current management of childhood neuropathic bladder: review of 156 cases.
Management of neuropathic bladder aims to maintain renal function and to secure appliance-free continence; because of recent advances, both objectives are theoretically attainable. Our present scheme of management, based upon preliminary video-urodynamic assessment, is outlined. In the years 1984-1988 we treated 156 children suffering from neuropathic bladder. In 5 per cent of cases the upper renal tracts have deteriorated on treatment; in patients presenting with upper tract dilatation, improvement has been obtained in 68 per cent. A quarter of the patients were considered too generally disabled to achieve appliance-free continence; these have been managed by penile appliance, indwelling urethral catheter or, occasionally, urinary diversion. For three-quarters of the patients, most ambulant, appliance-free continence was the goal; 68 per cent have been managed nonsurgically and 32 per cent surgically. Reliable day-time continence has been achieved in 78 per cent of the former and 86 per cent of the latter, 80 per cent overall.
Rickwood
A M
AM
Urology Department, Royal Liverpool Childrens Hospital, Great Britain.
Arnold
A J
AJ
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D004809:Ephedrine / Q000008:administration & dosage; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008333:Mandelic Acids / Q000008:administration & dosage; D010276:Parasympatholytics / Q000008:administration & dosage; D001743:Urinary Bladder / Q000601:surgery; D001748:Urinary Bladder Neck Obstruction / Q000601:surgery; D001750:Urinary Bladder, Neurogenic / Q000188:drug therapy / Q000601:surgery*; D014563:Urodynamics / Q000502:physiology
D008333:Mandelic Acids; D010276:Parasympatholytics; D004809:Ephedrine; C005419:oxybutynin