Our Summary

This research paper discusses the reasons why some people with a condition called neuropathic bladder might need surgery. This condition is when damage to the nerves that control the bladder causes issues like high pressure when storing urine, worsening problems in the upper urinary tract, and ongoing inability to control urination despite medication and other treatments.

Currently, the most common surgical procedure for neuropathic bladder is bladder augmentation, which increases bladder size and reduces the pressure during urine storage. However, this procedure can have significant risks in the long term.

The paper reviews both the medical and surgical treatments for neuropathic bladder, as well as the potential long-term effects of bladder augmentation.

FAQs

  1. What are the surgical indications for individuals with neuropathic bladder?
  2. What is the gold standard surgical procedure used for neuropathic bladder and what are its long-term risks?
  3. What does the medical and surgical management of neuropathic bladder involve?

Doctor’s Tip

A doctor might advise a patient undergoing pediatric urologic reconstruction to closely follow post-operative care instructions, including proper catheter care and regular follow-up appointments. It is important for the patient and their caregivers to understand the potential risks and complications associated with bladder augmentation surgery and to communicate any concerns or changes in symptoms to their healthcare provider promptly.

Suitable For

Patients who are typically recommended pediatric urologic reconstruction include those with neuropathic bladder, neurogenic bladder, and neuropathic bladder. These patients may have unsafe urinary storage pressures, progressive upper tract deterioration, continued urinary incontinence that is not responsive to oral medications or other therapies, and require intermittent catheterization. Bladder augmentation is often recommended to increase bladder capacity and reduce storage pressures in these patients. However, it is important to consider the long-term risks and consequences of bladder augmentation in these individuals.

Timeline

Before pediatric urologic reconstruction:

  1. Diagnosis of neuropathic bladder is made based on clinical symptoms, imaging studies, and urodynamic testing.
  2. Initial treatment may include medications, intermittent catheterization, and behavioral modifications to manage symptoms.
  3. As symptoms progress and conservative measures fail to adequately control the condition, surgery may be considered.
  4. Evaluation by a pediatric urologist to discuss surgical options, risks, and benefits of bladder reconstruction.

After pediatric urologic reconstruction:

  1. Bladder augmentation surgery is performed to increase bladder capacity and reduce storage pressures.
  2. Post-operative recovery period involves monitoring for complications such as infection, urinary retention, or bladder perforation.
  3. Long-term follow-up care is necessary to monitor bladder function, upper tract deterioration, and potential complications.
  4. Patients may require ongoing management with medications, intermittent catheterization, and other therapies to maintain bladder function.
  5. Potential long-term risks of bladder augmentation include urinary tract infections, electrolyte abnormalities, and decreased kidney function.
  6. Patients may experience improved quality of life with increased bladder capacity and better control of urinary symptoms.

What to Ask Your Doctor

  1. What are the risks and benefits of bladder augmentation surgery for pediatric patients with neuropathic bladder?
  2. How will bladder augmentation surgery affect my child’s quality of life in the long term?
  3. What alternative treatment options are available for pediatric patients with neuropathic bladder?
  4. How often will my child need follow-up appointments and monitoring after bladder augmentation surgery?
  5. What are the potential complications or side effects of bladder augmentation surgery in pediatric patients?
  6. How will bladder augmentation surgery impact my child’s ability to manage their bladder function independently?
  7. What is the success rate of bladder augmentation surgery in pediatric patients with neuropathic bladder?
  8. Will my child require any additional surgeries or treatments in the future after undergoing bladder augmentation?
  9. How can I best support my child during the recovery process after bladder augmentation surgery?
  10. Are there any lifestyle changes or modifications that my child will need to make after bladder augmentation surgery?

Reference

Authors: Roth JD, Cain MP. Journal: Urol Clin North Am. 2018 Nov;45(4):571-585. doi: 10.1016/j.ucl.2018.06.005. Epub 2018 Sep 7. PMID: 30316312