pediatrics
Bladder Anomalies
Neurogenic bladder
 Neurogenic Bladder is bladder dysfunction caused by neurologic disorders, including spinal cord or central nervous system abnormalities, trauma, or the sequelae of pelvic surgery (eg, for sacrococcygeal teratoma or The bladder may be flaccid, spastic, or a combination. A flaccid bladder has high-volume, low-pressure, and minimal contractions. A spastic bladder has normal or low-volume, high-pressure, and involuntary contractions. When present, chronically elevated bladder pressure (>40 cm H2O) often causes progressive kidney damage, even without infection or reflux. Manifestations include recurrent Urinary Tract Infection (UTI) in Children , urinary retention and/or The underlying neurologic abnormality is usually readily apparent. Usually, postvoiding residual volume is measured, renal ultrasonography is done to detect hydronephrosis, and serum creatinine is measured to assess renal function. Urodynamic testing is often done to confirm diagnosis and to monitor bladder pressures and function. These studies are often repeated at scheduled intervals as the child grows to assess for deterioration of bladder and renal function. Management goals include lowering risk of infection, maintaining adequate bladder storage pressure and volume, effective bladder emptying, and achieving social continence. Treatment of neurogenic bladder includes drugs (eg, anticholinergics, prophylactic antibiotics), intermittent catheterization, and/or surgical intervention (eg, augmentation cystoplasty, appendicovesicostomy, botulinum toxin injections, neurostimulation). Children with neurogenic bladder often also have a neurogenic bowel with Constipation in Children and 