Document Detail

Urologic care of the neurogenic bladder in children.
MedLine Citation:
PMID:  20569799     Owner:  NLM     Status:  MEDLINE    
Initial care of newborns with spina bifida centers on preventing bladder and upper tract damage from detrusor leak point pressure of greater than 40 cm H(2)O. The authors recommend using urodynamic-based management to select patients with elevated pressures for anticholinergic therapy and intermittent catheterization (CIC), using diapers and observation with biannual renal sonography for the remainder. At the age of toilet training, children who have urodynamic evidence of uninhibited contractions or rising pressure during filling are started on anticholinergics and CIC, or have their dosage increased until pressures less than 40 cm H(2)O and areflexia are achieved. Sphincter incompetency is diagnosed in incontinent children with pressures less than 40 cm H(2)O and areflexia or stress incontinence. Augmentation is indicated in patients with hydronephrosis or reflux and end-filling pressures or DLPP less than 40 cm H(2)O despite medical management to the point of patient tolerance. A minority of patients, not yet well-defined, will also need augmentation after bladder outlet surgery for similar postoperative indications.
Warren T Snodgrass; Patricio C Gargollo
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  The Urologic clinics of North America     Volume:  37     ISSN:  1558-318X     ISO Abbreviation:  Urol. Clin. North Am.     Publication Date:  2010 May 
Date Detail:
Created Date:  2010-06-23     Completed Date:  2010-07-09     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0423221     Medline TA:  Urol Clin North Am     Country:  United States    
Other Details:
Languages:  eng     Pagination:  207-14     Citation Subset:  AIM; IM    
Department of Urology, University of Texas Southwestern Medical Center and Children's Medical Center, Dallas, TX 75207, USA.
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MeSH Terms
Infant, Newborn
Spinal Dysraphism / complications
Urinary Bladder, Neurogenic / therapy*

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