Management of neuropathic bladder secondary to spina bifida: Twenty years' experience with a conservative approach

Abstract

Introduction: Treatment of neuropathic bladder secondary to spina bifida is an ongoing challenge. Although different management strategies and protocols are available in the literature, reliance on expert opinion remains fundamental. A conservative approach can be utilized, but patients must be closely monitored throughout the management process. The objective of this study was to review the management and outcomes of neuropathic bladder in spina bifida by appraising long-term bladder and renal function in patients treated at a medical center utilizing a conservative management style.

Methods: This is a single-center retrospective review of urology care for all spina bifida patients 5-19 years of age with a neuropathic bladder who attended follow-ups between April 2000 and April 2020. Only patients with more than 5 years of follow-up were included. Renal functions, continence and results of invasive video urodynamics (IUD) and any surgical interventions were recorded.

Results: Seventy-one patients (mean age = 10.5 years) were identified after exclusions. Bladder compliance between first and last IUDs increased significantly (p = 0.0056). Anticholinergic treatment was started at the first outpatient appointment. Intravesical botulinum toxin injection was the second line treatment in ten patients. 94% of patients had an end fill pressure below 40 cm H2O in their last IUD. 82% were socially continent (dry or occasional damp patches) with or without catheterisations at the age of 11.5 years. One patient in the cohort had bladder augmentation.

Conclusion: The optimal management of neuropathic bladder secondary to spina bifida remains controversial. Bladder and renal functional outcomes can be improved with close monitoring and less invasive management.

Keywords: conservative; intermittent catheterisation; management; neuropathic bladder; spina bifida; urodynamics.

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Copyright © 2022 Elagami, Abbas, Evans and Murphy.

Figures

Figure 1

Bladder capacity – observed/expected (O/E) ratio (mL/mL) at first and last recorded IUDs. Fifty-four patients who had more than one test available were included. Statistical significance was assessed using paired t-test, and a p-value < 0.05 was considered significant. IUD, invasive video urodynamics.

Figure 2

Bladder compliance (mL/cm H2O) at first and last recorded IUDs. Fifty-four patients who had more than one test available were included. Statistical significance was assessed using paired t-test, and a p-value < 0.05 was considered significant. IUD, invasive video urodynamics.