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Medline ® Abstract for Reference 33

of 'Etiology and clinical features of bladder dysfunction in children'

The nonneurogenic neurogenic bladder of early infancy.
Jayanthi VR, Khoury AE, McLorie GA, Agarwal SK
J Urol. 1997;158(3 Pt 2):1281.
PURPOSE: The nonneurogenic neurogenic bladder has traditionally been believed to represent a disorder of older children. We report on patients in whom congenital dysfunctional voiding may be the underlying cause of nonneurogenic neurogenic bladder in early infancy.
MATERIALS AND METHODS: We evaluated 5 male and 2 female patients newborn to 30 months old with dysfunctional neurogenic bladder and no evidence of neurological pathology or anatomical outflow obstruction. Presentation included prenatal hydronephrosis in 3 cases, urosepsis in 2 and failure to thrive in 2. Radiological and urodynamic investigations revealed thick walled, poorly compliant bladders in 5 patients and incomplete bladder emptying bordering on urinary retention in 2. There was significant upper tract pathology in all cases, including azotemia in 4, reflux in 4 and hydroureteronephrosis in 6. Due to poor bladder function, manifested by incomplete emptying or high storage pressures, all patients were initially treated with cutaneous vesicostomy.
RESULTS: Bladder appearance and function subsequently improved in 3 patients and vesicostomy was reversed. Three patients with persistently thickened bladders, including 2 with renal failure,underwent bladder augmentation. The remaining patient had improved bladder storage function but requires intermittent catheterization.
CONCLUSIONS: The nonneurogenic neurogenic bladder represents a rare, severe form of dysfunctional voiding that may be present even in the neonatal period.
Section of Pediatric Urology, Ohio State University, Columbus, USA.