Pediatr Nephrol (2008) 23:717–725 DOI 10.1007/s00467-007-0691-z EDUCATIONAL FEATURE The neurogenic bladder: medical treatment Carla Verpoorten & Gunnar M. Buyse Received: 24 August 2007 / Revised: 19 October 2007 / Accepted: 25 October 2007 / Published online: 19 December 2007 # IPNA 2007 Abstract Neurogenic bladder sphincter dysfunction (NBSD) can cause severe and irreversible renal damage and bladder-wall destruction years before incontinence becomes an issue. Therefore, the first step in adequate management is to recognize early the bladder at risk for upper- and lower-tract deterioration and to start adequate medical treatment proactively. Clean intermittent catheter- ization combined with anticholinergics (oral or intravesical) is the standard therapy for NBSD. Early institution of such treatment can prevent both renal damage and secondary bladder-wall changes, thereby potentially improving long- term outcomes. In children with severe side effects or with insufficient suppression of detrusor overactivity despite maximal dosage of oral oxybutynin, intravesical instillation is an effective alternative. Intravesical instillation eliminates systemic side effects by reducing the first-pass metabolism and, compared with oral oxybutynin, intravesical oxybutynin is a more potent and long-acting detrusor suppressor. There is growing evidence that with early adequate treatment, kidneys are saved and normal bladder growth can be achieved in children so they will no longer need surgical bladder augmentation to achieve safe urinary continence in adolescence and adulthood. Keywords Neurogenic bladder . Urinary continence . Anticholinergics . Intermittent catheterization . Urodynamics C. Verpoorten (*) : G. M. Buyse Department of Child Neurology, University Hospitals K.U. Leuven, Herestraat 49, B-3000 Leuven, Belgium e-mail: carla.verpoorten@uzleuven.be Abbreviations NBSD neurogenic bladder sphincter dysfunction MMC myelomeningocele CIC clean intermittent catheterization CISC clean intermittent self-catheterization DSD detrusor sphincter dyssynergia Introduction Neurogenic bladder sphincter dysfunction (NBSD) can develop as a result of a lesion at any level in the nervous system, including the cerebral cortex, spinal cord, or peripheral nervous system. Neurologic conditions in chil- dren leading to neurogenic bladder dysfunction are pre- dominantly congenital neural tube defects (including myelomeningocele, lipomeningocele, sacral agenesis, and occult lesions causing tethered cord). Acquired causes such as spinal cord tumors or trauma or sequelae of transverse myelitis are less frequent. Whereas from an etiologic standpoint neurogenic bladder dysfunction is a heteroge- neous group, medical management will be similar irrespec- tive of the underlying cause. The vast majority of knowledge about NBSD management comes from long- term experience with myelomeningocele (MMC), the most common neural tube defect. Following the institution of a general treatment policy with advances in neurosurgical and orthopedic treat- ments in previous decades, governing the associated NBSD has become crucial for improving quality of life and life expectancy in children with neural tube defects. In MMC patients, disordered innervation of the detrusor musculature and external sphincter adversely affects bladder function, which if untreated not only leads to DO00691; No of Pages