Conservative management in neurogenic bladder dysfunction.
OBJECTIVE
A few decades ago, urinary diversion, usually with an ileal conduit, was the ultimate outcome for most children with spina bifida. The revolutionary institution of clean intermittent catheterization has changed the algorithm totally. Furthermore many new drugs have been developed during the past decade and have decreased the need for surgery dramatically. In this article, we will focus on the most recent data on new modalities of therapy to help avoid urinary diversion or bladder augmentation.


RESULTS
In addition to clean intermittent catheterization and oxybutynin treatment, a new generation of anticholinergic medications, such as tolterodine, has been developed. For patients who drop out because of the side-effects of oral administration, new methods of administration are now available, including extended release and intravesical instillation. For those unresponsive, botulinum-A toxin and resiniferatoxin are two relatively new drugs in the field, administered as intravesical injection and instillation, respectively. Intravesical or transdermal electrical stimulation, sacral nerve stimulation and biofeedback therapy are under development, but as currently administered, are not yet completely successful.


CONCLUSIONS
Although life-saving in many respects, bladder augmentation introduces life-long risks of its own. Our goal in describing 'conservative' management is to prevent this step. Many alternatives to surgery are available now and more effective strategies are under development.
Aslan
Ahmet R
AR
Division of Urology, Albany Medical College, New York 12208, USA.
Kogan
Barry A
BA
D018726:Anti-Dyskinesia Agents / Q000627:therapeutic use; D001559:Benzhydryl Compounds / Q000627:therapeutic use; D001676:Biofeedback, Psychology; D001905:Botulinum Toxins / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D018680:Cholinergic Antagonists / Q000627:therapeutic use; D003408:Cresols / Q000627:therapeutic use; D004224:Diterpenes / Q000627:therapeutic use; D004599:Electric Stimulation Therapy; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008333:Mandelic Acids / Q000627:therapeutic use; D008591:Meningomyelocele / Q000150:complications; D018727:Muscarinic Antagonists / Q000627:therapeutic use; D010665:Phenylpropanolamine; D000068737:Tolterodine Tartrate; D001750:Urinary Bladder, Neurogenic / Q000188:drug therapy / Q000209:etiology / Q000628:therapy*; D014546:Urinary Catheterization / Q000379:methods
D018726:Anti-Dyskinesia Agents; D001559:Benzhydryl Compounds; D018680:Cholinergic Antagonists; D003408:Cresols; D004224:Diterpenes; D008333:Mandelic Acids; D018727:Muscarinic Antagonists; D010665:Phenylpropanolamine; D000068737:Tolterodine Tartrate; C024353:resiniferatoxin; D001905:Botulinum Toxins; C005419:oxybutynin