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The Importance of Early Diagnosis and Management of Pediatric Neurogenic Bladder Dysfunction
Neurogenic bladder dysfunction is a major source of urologic morbidity in children, especially in those with spina bifida (SB). Complications from progression of bladder dysfunction can include urinary tract infections (UTIs), urinary incontinence, upper tract deterioration, and renal dysfunction or...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Dove
2021
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Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8421253/ https://www.ncbi.nlm.nih.gov/pubmed/34513742 http://dx.doi.org/10.2147/RRU.S259307 |
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author | Hobbs, K Tyler Krischak, Madison Tejwani, Rohit Purves, J Todd Wiener, John S Routh, Jonathan C |
author_facet | Hobbs, K Tyler Krischak, Madison Tejwani, Rohit Purves, J Todd Wiener, John S Routh, Jonathan C |
author_sort | Hobbs, K Tyler |
collection | PubMed |
description | Neurogenic bladder dysfunction is a major source of urologic morbidity in children, especially in those with spina bifida (SB). Complications from progression of bladder dysfunction can include urinary tract infections (UTIs), urinary incontinence, upper tract deterioration, and renal dysfunction or failure. In these children, there has been a recent trend toward proactive rather than expectant management of neurogenic bladder. However, there is a lack of consensus on how to best achieve the three main goals of neurogenic bladder management: 1) preserving kidney function, 2) achieving continence (if desired by the family/individual), and 3) achieving social and functional urologic independence (if appropriate). Hence, our objective was to perform a narrative literature review to evaluate the approaches to diagnosis and management of pediatric neurogenic bladder dysfunction, with special focus on children with SB. The approach strategies vary across a spectrum, with a proactive strategy on one end of the spectrum and an expectant strategy at the other end. The proactive management strategy is characterized by early and frequent labs, imaging, and urodynamic (UDS) evaluation, with early initiation of clean intermittent catheterization (CIC) and proceeding with pharmacotherapy, or surgery if indicated. The expectant management strategy prioritizes surveillance labs and imaging prior to proceeding with invasive assessments and interventions such as UDS or pharmacotherapy. Both treatment strategies are currently utilized and data have historically been inconclusive in demonstrating efficacy of one regimen over the other. We performed a narrative literature evaluating proactive and expectant treatment strategies as they relate to diagnostics and management of Spina Bifida. From the available literature and our practice, a proactive strategy favors greater benefit in preventative management and may decrease risk of renal dysfunction compared with expectant management. |
format | Online Article Text |
id | pubmed-8421253 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Dove |
record_format | MEDLINE/PubMed |
spelling | pubmed-84212532021-09-09 The Importance of Early Diagnosis and Management of Pediatric Neurogenic Bladder Dysfunction Hobbs, K Tyler Krischak, Madison Tejwani, Rohit Purves, J Todd Wiener, John S Routh, Jonathan C Res Rep Urol Review Neurogenic bladder dysfunction is a major source of urologic morbidity in children, especially in those with spina bifida (SB). Complications from progression of bladder dysfunction can include urinary tract infections (UTIs), urinary incontinence, upper tract deterioration, and renal dysfunction or failure. In these children, there has been a recent trend toward proactive rather than expectant management of neurogenic bladder. However, there is a lack of consensus on how to best achieve the three main goals of neurogenic bladder management: 1) preserving kidney function, 2) achieving continence (if desired by the family/individual), and 3) achieving social and functional urologic independence (if appropriate). Hence, our objective was to perform a narrative literature review to evaluate the approaches to diagnosis and management of pediatric neurogenic bladder dysfunction, with special focus on children with SB. The approach strategies vary across a spectrum, with a proactive strategy on one end of the spectrum and an expectant strategy at the other end. The proactive management strategy is characterized by early and frequent labs, imaging, and urodynamic (UDS) evaluation, with early initiation of clean intermittent catheterization (CIC) and proceeding with pharmacotherapy, or surgery if indicated. The expectant management strategy prioritizes surveillance labs and imaging prior to proceeding with invasive assessments and interventions such as UDS or pharmacotherapy. Both treatment strategies are currently utilized and data have historically been inconclusive in demonstrating efficacy of one regimen over the other. We performed a narrative literature evaluating proactive and expectant treatment strategies as they relate to diagnostics and management of Spina Bifida. From the available literature and our practice, a proactive strategy favors greater benefit in preventative management and may decrease risk of renal dysfunction compared with expectant management. Dove 2021-09-02 /pmc/articles/PMC8421253/ /pubmed/34513742 http://dx.doi.org/10.2147/RRU.S259307 Text en © 2021 Hobbs et al. https://creativecommons.org/licenses/by-nc/3.0/This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/ (https://creativecommons.org/licenses/by-nc/3.0/) ). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (https://www.dovepress.com/terms.php). |
spellingShingle | Review Hobbs, K Tyler Krischak, Madison Tejwani, Rohit Purves, J Todd Wiener, John S Routh, Jonathan C The Importance of Early Diagnosis and Management of Pediatric Neurogenic Bladder Dysfunction |
title | The Importance of Early Diagnosis and Management of Pediatric Neurogenic Bladder Dysfunction |
title_full | The Importance of Early Diagnosis and Management of Pediatric Neurogenic Bladder Dysfunction |
title_fullStr | The Importance of Early Diagnosis and Management of Pediatric Neurogenic Bladder Dysfunction |
title_full_unstemmed | The Importance of Early Diagnosis and Management of Pediatric Neurogenic Bladder Dysfunction |
title_short | The Importance of Early Diagnosis and Management of Pediatric Neurogenic Bladder Dysfunction |
title_sort | importance of early diagnosis and management of pediatric neurogenic bladder dysfunction |
topic | Review |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8421253/ https://www.ncbi.nlm.nih.gov/pubmed/34513742 http://dx.doi.org/10.2147/RRU.S259307 |
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