My patient has a neurogenic bladder

Purpose of ReviewThe neurogenic bladder is a medical term that describes a variety of bladder and sphincter dysfunctions. There are two major dangerous functional problems in a child with neurogenic bladder: high intravesical pressure in the storage phase and high pressure during urination. Two basic goals for urologic treatment in those children are protection of urinary tract from complications and improvement of continence in older children. This review focuses on the current role of botulinum toxin treatment in children with neurogenic bladder.Recent FindingsAt the beginning, treatment in this group of children is conservative. Oral anticholinergic therapy is aimed at decreasing bladder pressures during the storage phase. Clean intermittent catheterization enables bladder emptying if voiding is insufficient. Nevertheless, in a number of children such an approach fails, in some patients, troublesome side effects occur. In cases when standard therapy provides no improvement or if complications develop on the proper conservative treatment, surgical procedures are suggested. Operations are aimed at the surgical enlargement of bladder capacity. There are some reports on the efficacy of cystoscopic detrusor botulinum toxin injections in the treatment of neurogenic bladder in children.SummaryCystoscopic administration of botulinum toxin represents an alternative method of treatment to surgery for children with neurogenic bladder and could be considered an alternative to oral anticholinergic therapy.

No AccessJournal of UrologyEditorial1 May 2011Interstitial Cells and Bladder Pathophysiology—Passive Bystanders or Active Participants? Karen D. McCloskey Karen D. McCloskeyKaren D. McCloskey More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.2587AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "Interstitial Cells and Bladder Pathophysiology—Passive Bystanders or Active Participants?." The Journal of Urology, 185(5), pp. 1562–1563 References 1 : Mechanisms of disease: specialized interstitial cells of the urinary tract–an assessment of current knowledge. Nat Clin Pract Urol2005; 2: 546. Google Scholar 2 : Morphology and localization of interstitial cells in the guinea pig bladder: structural relationships with smooth muscle and neurons. J Urol2005; 173: 1385. Link, Google Scholar 3 : The function of suburothelial myofibroblasts in the bladder. Neurourol Urodyn2007; 26: 914. Google Scholar 4 : The functional effects of a c-kit tyrosine inhibitor on guinea-pig and human detrusor. BJU Int2006; 97: 612. Google Scholar 5 : Suburothelial myofibroblasts in the human overactive bladder and the effect of botulinum neurotoxin type A treatment. Eur Urol2009; 55: 1440. Google Scholar 6 : Role of gap junctions in spontaneous activity of the rat bladder. Am J Physiol Renal Physiol2007; 293: F1018. Google Scholar 7 : Altered distribution of interstitial cells in the guinea pig bladder following bladder outlet obstruction. Neurourol Urodyn2008; 27: 330. Google Scholar 8 : Characterization of upper lamina propria interstitial cells in bladders from patients with neurogenic detrusor overactivity and bladder pain syndrome. J Cell Mol Med2011; . Epub ahead of print. Google Scholar 9 : Modulation of bladder myofibroblast activity: implications for bladder function. Am J Physiol Renal Physiol2008; 295: F688. Google Scholar 10 : Interstitial cells of Cajal in the human normal urinary bladder and in the bladder of patients with megacystis-microcolon intestinal hypoperistalsis syndrome. BJU Int2004; 94: 143. Google Scholar Centre for Cancer Research and Cell Biology, School of Medicine, Dentistry and Biomedical Sciences, Queen's University, Belfast, Northern Ireland, United Kingdom© 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 5May 2011Page: 1562-1563 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Karen D. McCloskey More articles by this author Expand All Advertisement PDF downloadLoading ...

ObjectiveThe mechanisms of neurogenic bowel dysfunction (NBD) and neurogenic bladder (NB), which are major consequences of spinal cord injury and occasionally degenerative lumbar disease. The following in patients with cauda equina syndrome who underwent posterior decompression surgery was investigated: (1) the preoperative prevalence of NBD and NB, measured using the Constipation Scoring System (CSS) and International Prostate Symptoms Score (IPSS); (2) the degree and timing of postoperative improvement of NBD and NB.MethodsWe administered the CSS and IPSS in 93 patients before surgery and at 1, 3, 6, and 12 months postoperatively. We prospectively examined patient characteristics, Japanese Orthopaedic Association (JOA) score, and postoperative improvements in each score.ResultsThe prevalence of symptomatic defecation and urinary symptoms at admission were 37 patients (38.1%) and 31 patients (33.3%), respectively. Among the symptomatic patients with defecation problems, 12 patients had improved at 1 month, 13 at 3 months, 14 at 6 months, and 13 at 12 months postoperatively. Among the symptomatic patients with urinary problems, 5 patients improved at 1 month, 11 at 3 months, 6 at 6 months, and 10 at 1 year postoperatively. Comparing patients with improved versus unimproved in CSS, the degree of JOA score improvement was a significant prognosis factor (p<0.05; odds ratio, 1.05).ConclusionThe prevalence of symptomatic defecation and urinary symptoms in patients with cauda equina syndrome was 38.1% and 33.3%, respectively. Decompression surgery improved symptoms in 30%–50%. These effects were first observed 1 month after the operation and persisted up to 1 year.

BACTERIURIA MANAGEMENT AND UROLOGICAL EVALUATION OF PATIENTS WITH SPINA BIFIDA AND NEUROGENIC BLADDER: A MULTICENTER SURVEY

Long-Term Followup After Endoscopic Treatment of Vesicoureteral Reflux with Dextranomer/Hyaluronic Acid Copolymer in Patients with Neurogenic Bladder

This is a review of the most current literature on the evaluation and management of the urinary system after spinal cord injury (SCI). Spinal cord injury virtually always results in some degree of neurogenic bladder (NGB) dysfunction. While it is widely accepted that NGB dysfunction is associated with an increased risk of urologic complications, consensus regarding screening for those complications, and medical or surgical management is not widely accepted. Regarding screening for complications, an annual renal ultrasound is an appropriate screening test to assess for renal pathology including stones. General guidelines for urodynamic evaluation in patients with SCI were recently published and do not explicitly recommend routine testing. Regarding NGB complications, neurogenic bladders are most prone to urinary tract infections and stones. Medical, equipment and surgical options are all aimed at decreasing the risk of these complications in SCI patients.

Current guidelines for patients with neurogenic bladder (NB) dysfunction suggest the use of self-intermittent catheterization with adherence to catheterization timers. Due to biorhythmic variability, unpredictable voiding times may occur. As a result, many patients abstain from extended social or work activities, turn to more secluded lifestyles, and generally experience a decrease in quality of life. Being able to know when to void is essential for patients with NB dysfunction. To solve the problem of variable void timings, wearable devices using near-infrared spectroscopy (NIRS) have been emergent and showed potential for bladder volume monitoring. Therefore, in this review, we provided a comprehensive overview of research which implemented NIRS for bladder volume monitoring, and discussed how the researchers validated their device by in-vitro methods and suggested a potential validation approach. A literature search using PubMed and Google Scholar was conducted on February 2023. Publications involving bladder volume monitoring incorporating NIRS technique with in-vitro validation was considered for review. Due to the novelty of NIRS being applied to bladder monitoring, there are a few possibilities to effectively validate this technique through in-vitro methods. Ballistics gel, which has been proven to be a versatile material for applications involving ultrasound, could be a suitable material when constructing a bladder phantom for in-vitro validation of NIRS technology. By outlining a more standardized in-vitro validation model based on ballistics gel, we hope to facilitate development in this field towards a more accurate and robust NIRS-based bladder monitoring device.

Background:Spinal cord injury (SCI) is one of the most disabling and destructive neurological diseases. Neurogenic bladder dysfunction (NBD) is one of the serious complications after SCI, 80% of patients after SCI will have neurogenic bladder symptoms. NBD after SCI may lead to urinary retention, urinary incontinence, and urinary tract infection. In severe cases, it can lead to renal failure or even death. NBD after SCI not only seriously affects the patient's quality of life but also physical and mental health. NBD after SCI is a social and medical problem. In recent years, more and more clinical studies prove that heat-sensitive can improve the clinical symptoms of NBD after SCI. Therefore, this article conducts a systematic evaluation and meta-analysis on the efficacy and safety of heat-sensitive moxibustion in treating NBD after SCI.Methods:Search 8 electronic databases including PubMed, Embase, Web of Science, The Cochrane Library, Clinical Trials, China National Knowledge Infrastructure, China Science and Technology Journal Database, Wanfang Database, and China Biomedical Literature Database. We will search above electronic databases from the inception to May 2021, without any language restriction. Clinical randomized controlled trials containing heat-sensitive moxibustion for NBD after SCI and eligible interventions(s) and outcome(s) were included, with no limitation of language and publication status. Two researchers will independently conduct literature search, screening, information extraction, quality assessment, and data analysis. Review Manager 5.3 software will be used for statistical analysis.Results:The findings will be submitted to a peer-reviewed publication.Conclusion:This systematic review and meta-analysis will provide a standard clinical decision-making guideline for heat-sensitive moxibustion treatment of NBD after SCI.INPLASY registration number:INPLASY202150071.

Urinary biomarkers such as neutrophil gelatinase-associated lipocalin (NGAL) and renalase hold promise for assessing kidney health, yet their role in the pediatric neurogenic bladder (NB) remains unclear. This study evaluates their clinical utility in detecting kidney dysfunction and their association with disease severity. A cross-sectional study included 44 patients with NB and 45 age- and gender-matched healthy children (reference group). Urinary NGAL and renalase levels were measured using ELISA. Patients with NB were categorized based on glomerular filtration rate (GFR) and kidney scarring. Biomarker levels were compared using the Mann-Whitney U test, and their correlations with functional parameters (DTPA, DMSA) were assessed using Spearman's correlation. Urinary NGAL and renalase levels were significantly higher in patients with NB than in the reference group (NGAL: 31.86 vs. 23.40pg/mg creatinine, p = 0.0345; renalase: 2.75 vs. 1.76ng/mg creatinine, p = 0.0493). Patients with NB with GFR < 60mL/min/1.73 m2 or kidney scarring had elevated NGAL (46.90 vs. 26.76pg/mg creatinine, p = 0.0406) and renalase (3.76 vs. 1.82ng/mg creatinine, p = 0.0050). Both biomarkers correlated inversely with GFR (NGAL: r = -0.3344, p = 0.0326; renalase: r = -0.4054, p = 0.0085) and increased with kidney scarring, suggesting their potential role in assessing kidney injury severity. Urinary NGAL and renalase are elevated in pediatric patients with NB, particularly in those with kidney dysfunction, and correlate with GFR and kidney scarring. These findings highlight their potential as non-invasive markers for early detection and monitoring of kidney impairment in NB. Future longitudinal studies are warranted to validate their diagnostic and prognostic utility.

Bladder dysfunction has been linked to the progression of renal failure in children with neurogenic bladder (NB) dysfunction. The purpose of this study was to determine whether bladder injuries in fetal rats with myelomeningocele (MMC) may be treated with folic acid. Pregnant Sprague-Dawley rats were randomly divided into three groups. On the 10th day of gestation, pregnant rats were intragastrically injected with all-trans retinoic acid (ATRA) (60 mg/kg) to induce MMC fetal rats. The same amount of olive oil was put into the control group to create normal fetal rats. The rats in the rescue group were given folic acid (40 mg/kg) by gavage 0.5 and 12 hr after ATRA therapy. Bladders were obtained via cesarean section on embryonic day E20.5 and examined for MMC. The histology of the fetuses was examined using hematoxylin and eosin staining, and immunohistochemistry (IHC) was utilized to determine the expression of α-smooth muscle actin (α-SMA) and neuron-specific nuclear-binding protein (NeuN). Furthermore, the levels of neuromuscular development-related and apoptotic proteins were determined by western blotting. The incidence of MMC in the model group was 60.6% (20/33) while it was much lower in the rescue group (21.4%). In comparison to the model group, the weight and crown-rump length of the fetal rats in the rescue group were significantly improved. IHC revealed that there was no significant difference in the expression of α-SMA and NeuN between the control and ATRA groups, while the expression levels decreased significantly in the MMC group. Western blot analysis showed that there was no significant difference between the model and ATRA groups, but the expression of the α-SMA protein and the β3-tubulin was much lower in the MMC group than in the control group. After the administration of folic acid, the α-SMA and β3-tubulin proteins considerably increased in the folic acid-rescued MMC group and folic acid-rescued ATRA group. Meanwhile, in the control group, the expression of cleaved caspase-3 in the bladder tissue was significantly higher, and the expression of poly (ADP-ribose) polymerase (PARP) protein was significantly lower compared to the control group. Folic acid therapy reduced cleaved caspase-3 expression while increasing PARP expression in comparison to the MMC group. NB in MMC fetal rats is associated with the reduction of bladder nerve and smooth muscle-related protein synthesis. However, folic acid therapy can help improve these functional deficiencies. Folic acid also exhibits strong anti-apoptotic properties against NB in MMC fetal rats.

Newborn infants who had neurogenic bladder dysfunction (NBD) have a normal upper urinary tract.Most of them will develop deterioration of renal function, and chronic kidney disease in case they donot received proper management. Renal damage is due to high detrusor pressures resulted from poorcompliance of the bladder, beside detrusor over-activity against a closed sphincter or detrusor sphincterdyssynergia.To preserve renal function and prevent deterioration of the kidneys, NBD must be treated immediatelyafter being diagnosed. Over the last few years there was great progress in the treatment of childrenwith the NBD. Neurogenic bladder dysfunction in children must be diagnosed early in life and thechild should receive the proper management, neglecting the case or improper management would endwith deleterious effect on the upper tract end with renal dysfunction and chronic kidney failure. Thereare different options for management. The type of management would be personalized for each caseand could be modified. Case series were presented to illuminate the early management value of childrenwith NBD in situation of unavailable of advanced methods of treatment.The different approaches for management including the recent approaches were reviewed. This caseseries elaborate the management of 24 Egyptian children with NBD and impairment of renal function.The children underwent cutaneous vesicostomy at early stages of the disease. The procedure was feasibleand protected the kidney from deterioration tell adolescence. This procedure is feasible in limitedhospital resources and/or low-middle income countries.

Background: This prospective study aimed to evaluate renal function using retinol binding protein 4 (RBP4), cystatin C, and glomerular filtration rate (GFR) in relation to physical activity and lesion level in children with neurogenic bladder (NB) post-myelomeningocele. Methods: Two groups were studied: 33 children with NB and 20 healthy controls. Data collected included demographic details, physical activity levels, uroflowmetry, urodynamic diagnosis, and renal function parameters. Urinary RBP4 and serum cystatin C were measured using ELISA, and GFR was calculated using the Schwartz formula. Results: The NB group had higher median serum cystatin C and urinary RBP4/creatinine ratios compared to the control group (0.28 vs. 0.22; 18.6 vs. 3.2, respectively). The participants were categorized based on activity levels, lesion levels, catheterization status, and urodynamic diagnosis. No differences in RBP4, cystatin C, or urodynamic diagnosis were observed according to activity and lesion levels. Significant differences in GFR were found based on activity and lesion levels, with higher median GFR in NB children (182.7 vs. 147.3). No differences were found between catheterized and non-catheterized children in the studied parameters. Conclusions: Elevated urinary RBP4 in NB patients suggests possible proximal renal tubule dysfunction. Higher serum cystatin C despite lower creatinine levels indicates altered renal function in NB children. Urinary RBP4 correlates positively with bladder pressure at maximum cystometric capacity, suggesting potential utility in therapy monitoring and modification.

&lt;b&gt;Objectives&lt;/b&gt; There is a risk that early neurogenic bladder and bowel dysfunction following acute spinal cord injury (SCI) may not be adequately managed on the acute hospital wards. The aim of this paper was to review optimal assessment and management of patients with neurogenic bladder and/or bowel dysfunction during acute care immediately following SCI. A secondary aim was to translate these findings into an accessible policy for clinical staff involved in the care of acute SCI patients.&lt;br&gt;&lt;b&gt;Methods&lt;/b&gt; A literature review was performed to identify the protocols and research describing the management of bladder and bowel dysfunction after acute SCI. The measures extracted were principles of practice, threshold measures and evaluation tools, and timelines of best care. Key findings relating to assessment, management and identification of the benefits of adhering to a protocol of clinical practice were summarised. Fidelity with evidence identified was evaluated, and practice gaps were recognised.&lt;br&gt;&lt;b&gt;Results&lt;/b&gt; A total of 12 papers and six guidelines for providing excellent care to patients with SCI were identified. Overall, a systematic and comprehensive assessment of bladder and bowel function and neurological impairment should be completed early following SCI. Management is best individualised to both prevent known sequelae and optimise current function and quality of life. Acute SCI bladder and bowel management pathways were developed based on evidence identified.&lt;br&gt;&lt;b&gt;Conclusions&lt;/b&gt; The study has identified that timely assessment and management of patients with spinal cord neurogenic bladder and/or bowel dysfunction during the acute phase is pivotal to optimising continence and mitigating risk of preventable harm prior to discharge to specialised spinal rehabilitation.

Investigation into neurogenic bladder in arthrogryposis multiplex congenita

Screening for depression and anxiety in childhood neurogenic bladder dysfunction