Neurogenic bladder-sphincter

Hoebeke P, Van Laecke E, Van Camp C et al (2001) One thousand video-urodynamic studies in children with non-neurogenic bladder sphincter dysfunction. BJU Int 87 575-580... 

Neurogenic Bladder in Infants and Children (Neurogenic Bladder-Sphincter Dysfunction)... 

Not recognized non-neurogenic bladder-sphincter dysfunction or neurogenic bladder... 

VUD is the combination of VCU with pressure/ flow/electromyographic studies of the lower urinary tract. It is the gold standard for the assessment of children with neurogenic bladder. It is only a second-step study in children with nonneurogenic bladder-sphincter dysfunction. 

A broad spectrum of terms such as nonneuro-pathic vesicourethral dysfunction (Koff 1984), overactivity of the bladder and striated urethral muscle (Van Gool et al. 1984), nonneuropathic or nonneurogenic bladder-sphincter dysfunction (Hoebeke et al. 1999), dysfunctional bladder (Hinman 1986), unstable bladder (Koff 1982), nonneurogenic neurogenic bladder (Allen 1977) and Hinman syndrome (Hinman 1986) is still in use for sometimes overlapping patterns of nonneurogenic bladder-sphincter dysfunction. 

Nonneurogenic neurogenic bladder or the so-called Hinman syndrome is at the extreme end of the spectrum of nonneurogenic bladder-sphincter dysfunction. This syndrome shows severe clinical manifestations including urinary retention, severe bladder-sphincter dysfunction, VUR, hydronephrosis and hydroureter and renal scarring. 

Myelomeningocele is the most common cause of the neurogenic bladder in children. Pressure volume characteristics determine the fate of the urinary tract. There are three predictive indicators for upper tract deterioration detrusor sphincter dyssynergia, high bladder-filling pressure, and poor bladder compliance. Expectant treatment can no longer be advocated. 

Preservation of the upper urinary tract is the central goal in the treatment of neurogenic bladder in children with myelodysplasia. Predictive indicators for upper urinary-tract fate are detrusor sphincter dys-synergia, high bladder-filling pressure, poor bladder compliance, moderate to severe fibrosis of the detrusor (OzKAN et al. 2005), high leak-point pressure, and vesicoureteric reflux (Seki et al. 2004). 

Table 27.2. Treatment options for children with primary VUR. Supportive measures such as awareness of UTl, treatment of non-neurogen ic bladder-sphincter dysfunction, constipation, vulvitis, and phimosis are mandatory in all. RTx renal transplantation, CRF chronic renal failure...

---