A change in the type of neurogenic dysfunction as a result of treatment of children with neurogenic bladder subject to surgery for a spinal hernia during the newborn period

The most severe consequence of a spinal hernia, affecting the entire life of a person, is a spinal neurogenic bladder. Its symptoms limit the child’s socialization, and the problem of urination needs constant use of various aids. At the same time, despite many studies in neurology, there are no significant shifts in the possibility of restoring the function of urination in spinal patients.

Purpose. The aim of study is to analyze the long-term results of correction of neurogenic bladder in children treated depending on the type of dysfunction with a history of surgery for spinal hernia.

Characteristics of children and research methods. 100 patients with spinal neurogenic bladder aged 1–15 years were examined, urodynamic studies were used. Depending on the state of the detrusor and sphincter, groups of patients were identified, in each of which treatment lasting at least a year was selected.

Results. With a differentiated approach to the choice of therapeutic tactics, depending on the type of neurogenic bladder, the presence of vesicoureteral reflux, urinary tract infection, it was possible to reduce the level of detrusor hypertension, if any, or activate the function of the atonic bladder. Individual options for urinary diversion were developed. With long-term therapy that stabilizes detrusor, a change in the type of neurogenic dysfunction occurred within a year in 98 patients, which required repeated urodynamic examination to change treatment tactics.

Conclusion. Clinical manifestations of spinal neurogenic bladder do not always accurately indicate the type of dysfunction. During the growth of the child, as well as under the influence of treatment, there is a change in the type of neurogenic bladder. Urodynamic examination makes it possible to determine the state of the detrusor and sphincter — and to select a pathogenetically justified treatment option. In case of impaired urination, neurogenic bladder should be corrected with customized self-catheterization. Urodynamics should be controlled in spinal patients at least once a year to correct treatment. 

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