Pediatric Neurogenic Bladder and Bowel Dysfunction: Will My Child Ever Be out of Diapers?
Abstract
CONTEXT:Managing patient and parent expectations regarding urinary and fecal continence
is important with congenital conditions that produce neurogenic bladder and bowel
dysfunction. Physicians need to be aware of common treatment algorithms and expected
outcomes to best counsel these families. OBJECTIVE:To systematically evaluate evidence
regarding the utilization and success of various modalities in achieving continence,
as well as related outcomes, in children with neurogenic bladder and bowel dysfunction.
EVIDENCE ACQUISITION:We performed a systematic review of the literature in PubMed/Medline
in August 2019. A total of 114 publications were included in the analysis, including
49 for bladder management and 65 for bowel management. EVIDENCE SYNTHESIS:Children
with neurogenic bladder conditions achieved urinary continence 50% of the time, including
44% of children treated with nonsurgical methods and 64% with surgical interventions.
Patients with neurogenic bowel problems achieved fecal continence 75% of the time,
including 78% of patients treated with nonsurgical methods and 73% with surgical treatment.
Surgical complications and need for revisions were high in both categories. CONCLUSIONS:Approximately
half of children with neurogenic bladder dysfunction will achieve urinary continence
and about three-quarters of children with neurogenic bowel dysfunction will become
fecally continent. Surgical intervention can be successful in patients refractory
to nonsurgical management, but the high complication and revision rates support their
use as second-line therapy. This is consistent with guidelines issued by the International
Children's Continence Society. PATIENT SUMMARY:Approximately half of children with
neurogenic bladder dysfunction will achieve urinary continence, and about three-quarters
of children with neurogenic bowel dysfunction will become fecally continent. Most
children can be managed without surgery. Patients who do not achieve continence with
nonsurgical methods frequently have success with operative procedures, but complications
and requirements for additional procedures must be expected.
Type
Journal articleSubject
Fecal continenceMyelomeningocele
Neurogenic bladder
Neurogenic bowel
Pediatric
Spina bifida
Urinary continence
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https://hdl.handle.net/10161/20062Published Version (Please cite this version)
10.1016/j.euf.2020.01.003Publication Info
Johnston, Ashley W; Wiener, John S; & Todd Purves, J (2020). Pediatric Neurogenic Bladder and Bowel Dysfunction: Will My Child Ever Be out of Diapers?.
European urology focus. 10.1016/j.euf.2020.01.003. Retrieved from https://hdl.handle.net/10161/20062.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
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Show full item recordScholars@Duke
John Samuel Wiener
Professor of Surgery
As a general pediatric urologist, Dr. Wiener is involved with all aspects of pediatric
urology as a clinician and researcher. His research interests are most focused, however,
on the urologic management of neurogenic bladder and spina bifida and the molecular
biology involving development of the genitourinary tract and disorders.Dr. Wiener
is the principal investigator at Duke for The National Spina Bifida Patient Registry
and Urologic Management of Young Children with

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