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49 - Surgery for neuropathic bladder and incontinence

from Part V - Urology

Published online by Cambridge University Press:  08 January 2010

Prasad Godbole
Department of Paediatric Urology, Sheffield Children's NHS Trust, UK
Duncan T. Wilcox
Pediatric Urology, University of Texas, Dallas, TX, USA
Mark D. Stringer
University of Otago, New Zealand
Keith T. Oldham
Children's Hospital of Wisconsin
Pierre D. E. Mouriquand
Debrousse Hospital, Lyon
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Children with a neuropathic bladder may have bladder characteristics ranging from a high pressure non-compliant small capacity bladder with a high outlet resistance (unsafe), on the one hand, to a compliant low pressure capacious bladder with low outflow resistance (safe), on the other. Most children will demonstrate a mixed picture, and bladder and outflow characteristics may change with time thereby necessitating regular surveillance.

The aims of management of these children are:(i) preservation of renal function (ii) attaining urinary continence and therefore (iii) enabling social integration and improvement in quality of life. These aims can be achieved with a container (reservoir), which is capacious and low pressure, adequate outflow resistance (bladder neck and sphincter muscle complex) and a conduit to keep the reservoir empty at regular intervals (urethra, Mitrofanoff conduit).

This chapter concentrates on the long-term outcomes of the various treatment options that have been used and will not describe the technical aspects for which the reader is referred to several excellent texts on the subject.

The treatment modalities described include non-surgical (CIC and pharmacotherapy) surgery of the outlet (bladder-neck procedures, minimally invasive procedures and sphincters), surgery of the reservoir (augmentation cystoplasty), continent catheterizable conduits (Mitrofanoff principle), and urinary diversion (vesicostomy, refluxing ureterostomy, and ileal conduit).

Pediatric Surgery and Urology
Long-Term Outcomes
, pp. 631 - 642
Publisher: Cambridge University Press
Print publication year: 2006

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