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 with 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:
� In all children with CP who have had a UTI
� In children with 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.
� In children with any of the following symptoms:� dribbling, high voiding frequency or urgency, difficulty initiating a void, stress incontinence, or 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).
� Any child with a change in bladder function, particularly if after intervention for spasticity with a Dorsal Rhizotomy.
Urology evaluation might include urodynamics (Cystometrogram/CMG), renal ultrasound, VCUG (if there has been a UTI), and a urinalysis.� Urology consultation may be considered.
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