title: Best practice in the assessment of bladder function in infants.
abstract: The purpose of this article is to review normal developmental bladder physiology in infants and bladder dysfunction in conditions such as neurogenic bladder, posterior urethral valves and high grade vesicoureteric reflux. We contrast the classical concept that bladder function in nontoilet-trained children is thought to be 'reflexive' or 'uninhibited', with the results of more recent research showing that infants most commonly have a stable detrusor. The infant bladder is physiologically distinct from the state seen in older children or adults. The voiding pattern of the infant is characterized by an interrupted voiding stream due to lack of proper urinary sphincter relaxation during voiding. This is called physiologic detrusor sphincter dyscoordination and is different from the pathologic 'detrusor sphincter dyssynergy' seen in patients with neurogenic bladder. Urodynamic abnormalities in neonates born with spina bifida are common and depend on the level and severity of the spinal cord malformation. Upper neuron lesions most commonly lead to an overactive bladder with or without detrusor sphincter dyssynergy while a lower neuron lesion is associated with an acontractile detrusor with possible denervation of the external urinary sphincter. In infants with neurogenic bladder, the role of 'early prophylactic treatment (clean intermittent catheterization and anticholinergics)' versus initial 'watchful waiting and treatment as needed' is still controversial and needs more research. Many urodynamic-based interventions have been suggested in patients with posterior urethral valves and are currently under scrutiny, but their impact on the long-term outcome of the upper and lower urinary tract is still unknown. Cumulative data suggest that there is no benefit to early intervention regarding bladder function in infants with high-grade vesicoureteric reflux.
authors.affiliation: Division of Urology, Children's Hospital of Eastern Ontario (CHEO), 401 Smyth Rd, Ottawa, ON, Canada K1H 8L1.
authors.forename: Luis
authors.initials: L
authors.lastname: Guerra
authors.affiliation: Department of Surgery, Division of Pediatric Urology, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada.
authors.forename: Michael
authors.initials: M
authors.lastname: Leonard
authors.affiliation: Section of Paediatric Urology, Urology Unit, University Hospital of Padova, Padua, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Castagnetti
keywords: bladder function; children; infant; neurogenic bladder; pediatric; urodynamics
references.citation: J Pediatr Surg. 1984 Dec;19(6):838-42
references.pmid: 6520683
references.citation: J Urol. 1999 Jun;161(6):1928-33
references.pmid: 10332475
references.citation: Am J Dis Child. 1992 Jul;146(7):840-3
references.pmid: 1496955
references.citation: BJU Int. 2001 Apr;87(6):575-80
references.pmid: 11298061
references.citation: J Pediatr Surg. 1996 Mar;31(3):407-10
references.pmid: 8708913
references.citation: J Urol. 1995 Aug;154(2 Pt 2):708-11
references.pmid: 7609159
references.citation: Br J Urol. 1997 Nov;80(5):806-8
references.pmid: 9393308
references.citation: Pediatr Surg Int. 1999 Jul;15(5-6):358-62
references.pmid: 10415286
references.citation: J Urol. 1999 Nov;162(5):1733-7; discussion 1737-8
references.pmid: 10524925
references.citation: Neurourol Urodyn. 2009;28(8):959-63
references.pmid: 19260083
references.citation: Pediatr Surg Int. 2009 Dec;25(12):1113-5
references.pmid: 19727771
references.citation: J Urol. 2004 Feb;171(2 Pt 1):829-33; discussion 833
references.pmid: 14713836
references.citation: Urol Clin North Am. 1990 May;17(2):379-87
references.pmid: 2336746
references.citation: Radiology. 1993 Apr;187(1):161-4
references.pmid: 8451405
references.citation: JAMA. 1984 Aug 3;252(5):650-2
references.pmid: 6737668
references.citation: J Urol. 1996 May;155(5):1711-5
references.pmid: 8627867
references.citation: J Urol. 2007 Nov;178(5):2142-7; discussion 2147-9
references.pmid: 17870121
references.citation: J Urol. 2003 Oct;170(4 Pt 2):1681-5; discussion 1685
references.pmid: 14501691
references.citation: Scand J Urol Nephrol Suppl. 1976;(37):1-106
references.pmid: 150023
references.citation: J Urol. 2004 Jun;171(6 Pt 1):2423-6
references.pmid: 15126867
references.citation: Pediatr Nephrol. 2008 Apr;23(4):541-51
references.pmid: 18270749
references.citation: Urology. 2010 Oct;76(4):942-5
references.pmid: 20579700
references.citation: BJU Int. 2011 Mar;107(6):994-9
references.pmid: 20860652
references.citation: J Urol. 1981 Aug;126(2):205-9
references.pmid: 7196460
references.citation: J Urol. 2006 Oct;176(4 Pt 2):1729-32
references.pmid: 16945634
references.citation: Br J Urol. 1995 Aug;76(2):235-40
references.pmid: 7663918
references.citation: Eur Urol. 2006 May;49(5):908-13
references.pmid: 16458416
references.citation: BJU Int. 2005 Aug;96(3):397-400
references.pmid: 16042737
references.citation: J Urol. 2004 Jul;172(1):27-33
references.pmid: 15201731
references.citation: J Urol. 1999 Sep;162(3 Pt 2):1068-71
references.pmid: 10458433
references.citation: J Urol. 2000 Dec;164(6):2050-4
references.pmid: 11061923
references.citation: J Urol. 1987 Oct;138(4 Pt 2):1110-2
references.pmid: 3656569
references.citation: J Urol. 1989 Aug;142(2 Pt 2):494-8; discussion 501
references.pmid: 2746764
references.citation: J Urol. 2001 Jun;165(6 Pt 2):2383-8
references.pmid: 11371982
references.citation: Neurourol Urodyn. 2007;26(2):222-7
references.pmid: 17009254
references.citation: J Urol. 1996 Nov;156(5):1809-12
references.pmid: 8863622
references.citation: J Urol. 1996 Dec;156(6):2031-3
references.pmid: 8965337
references.citation: Acta Physiol (Oxf). 2013 Jan;207(1):85-92
references.pmid: 23088436
references.citation: J Urol. 1997 Sep;158(3 Pt 2):1281-5
references.pmid: 9258195
references.citation: J Urol. 2002 Oct;168(4 Pt 2):1844-8; discussion 1848
references.pmid: 12352373
references.citation: J Urol. 2004 Oct;172(4 Pt 2):1657-61; discussion 1661
references.pmid: 15371784
references.citation: J Urol. 1997 Sep;158(3 Pt 2):1011-6
references.pmid: 9258132
references.citation: BJU Int. 2000 Jun;85(9):1104-8
references.pmid: 10848705
references.citation: J Urol. 2009 Apr;181(4):1857-61
references.pmid: 19233405
references.citation: J Urol. 2007 Sep;178(3 Pt 1):761-8; discussion 768
references.pmid: 17631323
references.citation: J Urol. 1995 Aug;154(2 Pt 2):889-92
references.pmid: 7609206
references.citation: Dev Med Child Neurol. 1983 Oct;25(5):612-6
references.pmid: 6354799
references.citation: Br J Urol. 1998 Mar;81(3):461-7
references.pmid: 9523671
references.citation: Urology. 2003 Oct;62(4 Suppl 1):3-9
references.pmid: 14550831
references.citation: J Pediatr Urol. 2011 Feb;7(1):39-43
references.pmid: 20363192
references.citation: J Urol. 1982 Nov;128(5):994-7
references.pmid: 7176067
references.citation: J Urol. 1998 Oct;160(4):1477-81
references.pmid: 9751398
references.citation: J Urol. 2002 Jan;167(1):291-7
references.pmid: 11743343
references.citation: J Urol. 2006 Jul;176(1):314-24
references.pmid: 16753432
references.citation: Dev Med Child Neurol. 2012 Oct;54(10):945-50
references.pmid: 22788916
references.citation: Scand J Urol Nephrol Suppl. 2004;(215):69-74
references.pmid: 15545200
references.citation: J Urol. 2004 Jun;171(6 Pt 1):2409-12
references.pmid: 15126863
references.citation: J Urol. 2012 Jun;187(6):2195-200
references.pmid: 22503009
references.citation: Nat Rev Urol. 2010 Jul;7(7):371-7
references.pmid: 20531385
references.citation: J Urol. 2007 Jan;177(1):325-9; discussion 329-30
references.pmid: 17162079
references.citation: J Urol. 2010 Feb;183(2):694-8
references.pmid: 20022052
references.citation: J Urol. 1996 Feb;155(2):673-7
references.pmid: 8558700
references.citation: J Urol. 2013 Feb;189(2):678-83
references.pmid: 22982430
references.citation: J Urol. 1997 Sep;158(3 Pt 2):1017-21
references.pmid: 9258133
references.citation: J Neurosurg. 2006 Nov;105(5 Suppl):391-5
references.pmid: 17328264
references.citation: J Urol. 1997 Mar;157(3):984-8
references.pmid: 9072631
references.citation: J Pediatr Urol. 2013 Oct;9(5):659-64
references.pmid: 22921013
references.citation: J Urol. 2012 Oct;188(4 Suppl):1516-20
references.pmid: 22910256
references.citation: J Urol. 2009 Oct;182(4 Suppl):1945-8
references.pmid: 19695619