Children born with a spinal defect often have neurological problems affecting the lower limbs, bladder and rectum. Many patients have neuropathic bladders and may require surgery because of severe voiding dysfunction. Options include management by either an indwelling catheter, ISC or urinary diversion. Due to immobility and chronically poor voiding, renal stone formation and recurrent UTIs are common.
Traumatic spinal injury may result in paraplegia and an abnormally functioning bladder. Initially, during spinal shock, there is suppression of autonomic and somatic activity and the bladder becomes acontractile, areflexic and painlessly distended. It must therefore be drained, to prevent overdistention injury. As the neurological lesion stabilizes, reflex voiding may return, but this depends on the level of injury. Detrusor hyper-reflexia and DSD may also be present. Self-catheterization, a permanent indwelling catheter or urinary diversion are all options. Renal stone disease is common due to immobility and urinary stasis.
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