The Importance of Early Diagnosis and Management of Pediatric Neurogenic Bladder Dysfunction.
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2021-01
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Abstract
Neurogenic bladder dysfunction is a major source of urologic morbidity in children, especially in those with spina bifida (SB). Complications from progression of bladder dysfunction can include urinary tract infections (UTIs), urinary incontinence, upper tract deterioration, and renal dysfunction or failure. In these children, there has been a recent trend toward proactive rather than expectant management of neurogenic bladder. However, there is a lack of consensus on how to best achieve the three main goals of neurogenic bladder management: 1) preserving kidney function, 2) achieving continence (if desired by the family/individual), and 3) achieving social and functional urologic independence (if appropriate). Hence, our objective was to perform a narrative literature review to evaluate the approaches to diagnosis and management of pediatric neurogenic bladder dysfunction, with special focus on children with SB. The approach strategies vary across a spectrum, with a proactive strategy on one end of the spectrum and an expectant strategy at the other end. The proactive management strategy is characterized by early and frequent labs, imaging, and urodynamic (UDS) evaluation, with early initiation of clean intermittent catheterization (CIC) and proceeding with pharmacotherapy, or surgery if indicated. The expectant management strategy prioritizes surveillance labs and imaging prior to proceeding with invasive assessments and interventions such as UDS or pharmacotherapy. Both treatment strategies are currently utilized and data have historically been inconclusive in demonstrating efficacy of one regimen over the other. We performed a narrative literature evaluating proactive and expectant treatment strategies as they relate to diagnostics and management of Spina Bifida. From the available literature and our practice, a proactive strategy favors greater benefit in preventative management and may decrease risk of renal dysfunction compared with expectant management.
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Hobbs, K Tyler, Madison Krischak, Rohit Tejwani, J Todd Purves, John S Wiener and Jonathan C Routh (2021). The Importance of Early Diagnosis and Management of Pediatric Neurogenic Bladder Dysfunction. Research and reports in urology, 13. pp. 647–657. 10.2147/rru.s259307 Retrieved from https://hdl.handle.net/10161/29065.
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J Todd Purves
John Samuel Wiener
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 Spina Bifida protocol administered by the Centers for Disease Control and Prevention. These projects began at Duke in 2011 and 2015, respectively.
Dr. Wiener was previously a project director for the P50 Center for Undiagnosed Pediatric and Urogenital Disorders.
Dr. Wiener has served in national leadership positions in pediatric urology including President of the Society of Fetal Urology, Executive Council of Society for Pediatric Urology, and the Examination Committee of the American Board of Urology. He is currently on the Board of Directors of the Spina Bifida Association
Jonathan Charles Routh
I am a pediatric urologist and health services researcher who is interested in caring for children with urological problems, conducting research on how to improve that care, and mentoring young researchers to ensure that the next generation does both better than I currently can.
My clinical interests include minimally-invasive surgery, neurogenic and non-neurogenic voiding dysfunction, complex urologic reconstruction (particularly in children with spina bifida), and pediatric urologic oncology (particularly Wilms tumor and rhabdomyosarcoma). My research has been funded by awards from the NIH, CDC, FDA, and multiple foundations and industry partners, and during my time on faculty at Duke I have had the pleasure of collaborating with many groups and individuals around the world on a number of projects. Over the past 15 years, I have formally mentored nearly 3 dozen undergraduates, medical students, urology residents, post-doctoral students, and junior faculty members across multiple disciplines (pediatrics, urogynecology, urology, and nursing).
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