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Neurogenic Bladder, Modern Treatment (Abstract)

Tom P.V.M. de Jong
Utrecht, The Netherlands

 

Abstract 

Renal damage and renal failure are still reported as complications of spina bifida. We have been using a protocol for spina bifida treatment over the last 16 years that minimises renal scarring to 0,5% of all patients. Moreover, the majority of patients are continent for urine when going to primary school. A pro-active treatment of detrusor and sphincter overactivity from birth on is mandatory to obtain such results since upper urinary tract changes occur in the first months of life. This implies that every neonate with spina bifida is treated by clean intermittent catheterisation and pharmacological suppression of detrusor overactivity from birth on. Later in life, therapy can be tailored to the urodynamic specifications of bladder and sphincter. For children with urinary incontinence, surgery to become dry has been routinely offered around the age of 5 years. We have been using rectus abdominis sling suspension of the bladder neck with good results, both in male and in female patients. As an alternative for ileocystoplasty, detrusorectomy can be done to lower intravesical pressures provided that adequate bladder capacity is present.

 

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