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Paediatric Surgery
Neurogenic Bladder
Built from Puri — Pediatric Surgery and Pediatric Urology
What’s inside
14 sections · 96 slides
Overview
- What this deck will teach you
What Is a Neurogenic Bladder?
A bladder whose nerve control has failed
- The idea in plain terms
- Why it matters — the two enemies
- Three broad groups
- Classifying the neurogenic bladder
How the Normal Bladder Works
Build the machine before you study its failure
- The bladder as an organ
- The detrusor — the emptying muscle
- The urothelium — more than a lining
- The two urethras compared
- The nerve supply — a memorable rule
- The nerve supply of the lower urinary tract
- Bladder behaviour in infancy
- Bladder capacity grows in jumps, not smoothly
- Voiding pressures fall with age
What Causes It
From neural tube defects to acquired injury
- Primary NB — a real neurological lesion
- Secondary (neuropathic) NB
- Idiopathic NB — rare and by exclusion
- Neural tube defects — the dominant cause
- Neural tube defects by the numbers
- Prevention is changing the numbers
- Open versus closed — very different risk
- Fetal surgery softens the bladder outlook
- Acute demyelinating syndromes (ADS)
- Guillain-Barré and cerebral palsy
Looking Inside the Bladder
Examination, imaging and urodynamics
- The bedside starting point
- Initial assessment of the child
- Ultrasound — useful but not enough
- Video urodynamics — the seven Cs (1 of 2)
- Video urodynamics — the seven Cs (2 of 2)
- Estimating expected bladder capacity (EBC)
- DMSA — finding the scars
- How a urodynamic study is done
- Filling versus voiding phases
- Video-urodynamic tracings in children with spina bifida
Treating It — Medicine First
Catheters, bladder relaxants and botulinum toxin
- The guiding philosophy
- The newborn with myelomeningocele
- Infancy: safety before continence
- Closed NTD: a middle road
- School age and the teenage years
- Anticholinergics — the workhorse drugs
- Which muscarinic receptor?
- Newer relaxants and a different lever
- Botulinum toxin for refractory overactivity
- Botulinum toxin — the limits
- Injecting botulinum toxin into the bladder wall
- Acute-onset NB after injury or ADS
Reflux in the Neurogenic Bladder
When high pressure drives urine backwards
- Secondary vesicoureteral reflux (VUR)
- Untreated NB destroys the kidney
- Surgery for reflux — augmentation first
- Endoscopy and reimplantation in NB
Surgery to Buy Safe Storage
Dilation, vesicostomy and detrusorotomy
- Urethral dilation
- Vesicostomy
- Detrusorotomy (autoaugmentation)
Bladder Augmentation
Enlarging the reservoir with a patch of bowel
- The principle
- Ileum — the popular choice (ileocystoplasty)
- Cup ileocystoplasty
- The catch with ileum — vitamin B12
- Other bowel segments
- Stomach (gastrocystoplasty) — mostly abandoned
- General complications of using bowel
- Living with a bowel patch — mucus and stones
- The malignancy question
- Metabolic derangements
- Alternatives that avoid bowel
A Channel for Catheterisation
The Mitrofanoff principle
- The Mitrofanoff principle
- When there is no appendix — Monti tubes
Raising Outlet Resistance
Procedures for the leaky bladder neck
- The outlet problem — and its danger
- Bladder neck injections
- Slings and sphincters
- Reconfiguring the bladder neck
The Transplant Patient
A safe bladder for a precious graft
- Why the transplant bladder is special
- Preparing the bladder — and the anuric dilemma
The Bowel Is Part of the Bladder
Managing neurogenic constipation
- Why bowel care is bladder care
- Stepwise management of constipation
- Laxatives and washouts
- Antegrade continence enema (MACE)
Bringing It Together
The essentials to carry away
- Key takeaways
- Why does a low-compliance neurogenic bladder threaten the kidneys?
- References (1/3)
- References (2/3)
- References (3/3)
- Pediatric Surgery and Pediatric Urology