Neurogenic Bladder
Routine evaluation of the urinary tract is not indicated in children with CP. However, some children with CP may have a neurogenic
bladder resulting in difficulty attaining continence or urinary tract infections. Studies have suggested that these children
have excellent responses to treatment with the majority achieving continence.
Urology evaluation should be considered in the following situations:
- patients who have had a UTI ;
- persistent daytime incontinence despite a good training approach (see Toilet Training Children With Disability). Note: with the appropriate approach, even children with moderately severe cognitive and motor impairments can achieve continence;
- changes in bladder function, particularly if after intervention for spasticity with a Dorsal Rhizotomy;
- in children with any of the following symptoms:
- dribbling;
- high voiding frequency or urgency;
- difficulty initiating a void;
- stress incontinence; and
- persistent nighttime wetting after a period of daytime continence. (Note: an empiric trial of ditropan might be considered in those with symptoms of bladder spasticity).
- urodynamics (Cystometrogram/CMG);
- renal ultrasound;
- VCUG (if there has been a UTI); and
- a urinalysis.
Resources
Helpful Articles
McNeal DM, Hawtrey CE, Wolraich ML, Mapel JR.
Symptomatic neurogenic bladder in a cerebral-palsied population.
Dev Med Child Neurol.
1983;25(5):612-6.
PubMed abstract
This is an older article but the only one that looks at urinary symptoms in a general clinic population of children with CP.
Reid CJ, Borzyskowski M.
Lower urinary tract dysfunction in cerebral palsy.
Arch Dis Child.
1993;68(6):739-42.
PubMed abstract / Full Text
This article describes clinical features and management of a cohort of children with CP referred to a urology clinic.