Contemporary approach to neurogenic urinary bladder in children

Neurogeni mokraćni mjehur (NMM) uzrokovan je oštećenjem inervacije donjeg mokraćnog sustava i predstavlja rizik za ponavljane upale mokraćnog sustava, nastanak vezikoureteralnog refluksa, hidronefroze, urolitijaze i oštećenje bubrežne funkcije. Urodinamska ispitivanja omogućila su nam bolje razumijevanje patofiziologije ovih poremećaja i rano otkrivanje čimbenika rizika za oštećenje bubrežnog parenhima. Odmah nakon postavljanja sumnje na neurogeni poremećaj nužna je kompletna nefrološka obrada koja uključuje ultrazvučne metode, 4 satnu opservaciju mokrenja, kontrastnu mikcijsku urosonografiju, urodinamiku i videourodinamiku. Glavni ciljevi liječenja i praćenja su očuvanje bubrežne funkcije, a nakon školske dobi i socijalno prihvatljiva kontinencija. U ovom radu iznosimo suvremeni pristup djetetu s neurogenim mokraćnim mjehurom uz osvrt na vlastito dugogodišnje iskustvo u dijagnostici i liječenju djece i adolescenata s raznim oblicima ovog poremećaja.Neurogenic urinary bladder is caused by impaired innervation of the lower urinary tract and is a risk factor for recurrent urinary tract infections, vesicoureteral reflux, hydronephrosis, urolithiasis and impaired renal function. Urodynamic studies have allowed us to better understand the pathophysiology of these disorders and early detection of risk factors for renal parenchymal damage. Immediately after the suspicion on a neurogenic dysfunction, complete diagnostic workup is necessary, which includes ultrasound methods, 4-hour voiding observation, contrast-enchanced voiding urosonography, urodynamics and videourodynamics. The main goals of treatment and follow-up are the preservation of renal function, and after school age, socially acceptable continence. In this paper, we present contemporary approach to a child with neurogenic bladder with reference to our own many years of experience in the diagnosis and treatment of children and adolescents with various forms of this disorder