Diagnostic evaluation in children with neurogenic bladder

Diagnostic evaluation in children with neurogenic bladder dysfunction (NBD) early in life, focuses on diagnosing the type of bladder and sphincter abnormalities present, whether or not there is an overactive detrusor, what is the innervation to the external urethral sphincter and how does it react when the bladder is full and begins to empty, and what is the optimal treatment protocol to choose. Imaging of the kidneys is done routinely during regular clinic visits more frequently at younger ages and less so at later ages to insure that treatment protocol maintains safe factors over time for the preservation of upper urinary tract function. Urodynamic studies (UDS) are needed to assess that storage function of the bladder remains at pressures low enough for upper urinary tract safety and to evaluate the adequacy of treatment of detrusor overactivity, and to determine sphincter reactivity to bladder emptying. In incontinent children, UDS are needed to choose the optimal combination of bladder and bladder neck surgery to ensure dryness and as the best quality of life possible for these patients. MRI may be needed to diagnose primary and/or secondary tethering of the spinal cord and to design future therapeutic interventions by neurosurgery.