Neurogenic Bladder

Treatments

In most cases, there is no cure for neurogenic bladder, but our pediatric urologists offer advanced treatments that help children maintain a degree of continence, protect their kidneys and make life better.

Treatment is determined by several factors such as:

• The age of the child
• Other health conditions
• Health history
• Diagnostic tests that show how well each child’s bladder stores and empties urine

Our pediatric urologists are experienced specialists who offer a range of treatments for children with neurogenic bladder dysfunction. Among the options are:

• Training. In many cases, our Pediatric Continence Program can help children manage neurogenic bladder by teaching them how to empty their bladders on a certain schedule.
• Medications. Various medications may be used. Anticholinergic drugs may be used to help the bladder relax and store urine at lower pressure. Other medications stimulate nerve activity to enhance continence.
• Catheterization and Catheterizable Channels. Some children cannot empty their bladders unless they are catheterized at regular intervals. Catheterization is most often performed through the urethra. In some circumstances, a channel can be created to catheterize. This avoids exposing the genitalia for catheterization and is generally easier and less sensitive for the child. A catheterizable channel is a surgical procedure that uses a piece of bowel or appendix to make a channel that connects the skin of the abdominal wall to the bladder. The channel will not leak urine and can be used to empty the bladder.
• Continuous Bladder Drainage. A small subset of children have such unsafe bladders that the only way to avoid kidney damage is to allow for continuous drainage of the bladder. Placing a catheter in at all times is rarely a good long-term solution in children. In small children, the bladder can be continuously drained by connecting the top of the bladder to the abdominal wall in a procedure known as a vesicostomy. In older children, the bladder is positioned further away from the abdominal wall, and it is therefore often necessary to connect the top of the bladder to the abdominal wall with a piece of intestine. This procedure is known as an ileal chimney or incontinent ileovesicostomy. In rare cases, when the bladder is very diseased, urine flow may need to be completely diverted away from the bladder. This procedure is known as an ileal or colon conduit. In this procedure, the ureters are disconnected from the bladder and inserted directly into a piece of bowel that is brought up to the abdominal wall as a stoma. The bladder may be removed at the time of this surgery.
• Bladder Augmentation. For children with unsafe bladders who want to have control of their urine and not have to wear a bag or diaper, a bladder augmentation is a good option. This procedure is useful when medications and bladder injections don’t work. If the child and family can catheterize dependably, the child may be a candidate for a bladder enlargement procedure known as an enterocystoplasty or bladder augmentation. The bladder can be enlarged using a piece of intestine, and expanding the bladder’s size can lower the bladder pressures, increase the bladder’s ability to store increased amounts of urine safely, and sometimes relieve painful bladder spasms. Afterward, children almost always need to catheterize to empty their bladders, because the bladder can’t squeeze normally after the procedure. In very rare cases, the bladder can be mildly enlarged without using a piece of intestine in a procedure known as a bladder autoaugmentation.
• Bladder injections. The use of Botox® or botulinum toxin has been used to relax the bladder in patients with neurogenic bladder. This medication can delay or avoid a surgical procedure, but it may need to be repeated every six to nine months to remain effective.
• Bladder Replacement. In rare cases in which children are born without a bladder or the bladder has to be removed because of cancer or disease, it may be necessary to create an entirely new bladder out of the intestine. This procedure is known as a continent urinary reservoir. Since the reservoir is made entirely out of the intestine, it requires catheterization to be emptied. A channel is therefore created at that time of surgery so that the bladder can be emptied from a stoma on the abdomen.
• Bowel Management. Many children with neurogenic bladders also have abnormal bowel function and trouble with stool accidents and constipation. A bowel regimen with stool softeners and enemas can be beneficial to many patients. Typically, enemas are performed in a retrograde fashion (in a direction opposite to the normal flow of stool) and evacuation of the stool occurs through the rectum. If the sphincter muscles don’t work well, these types of enemas are usually not successful. Children whose stool accidents do not improve with medication or enemas may be candidates for the Malone antegrade continence enema (MACE or ACE) procedure. This is a procedure in which the appendix is brought up to the abdominal wall as a stoma. A catheter can be inserted through the appendix into the beginning of the colon. An enema can then be performed that can flush all of the stool out of the colon from beginning to end in the normal direction stool flows. This can be very helpful in managing severe constipation and will often prevent a child from leaking stool for 24-48 hours.

Depending on the cause of neurogenic bladder, your child may need to be closely monitored throughout life. With conditions such as spina bifida, for example, the bladder may do well for a while and then deteriorate. The Spina Bifida Program at Riley at IU Health supports children through a range of ongoing health complications related to their condition, including neurogenic bladder dysfunction.

Riley Children's Hospital is home to one of the nation’s top ranked programs for pediatric urinary care, including reconstructive surgeries and bladder augmentation. Our world-renowned surgeons are expertly qualified to treat your child for neurogenic bladder dysfunction.