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Reflux in MCU with NEUROGENIC BLADDER. SACRAL NERVE STIMULATION?

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Hi,

My daughter Jahnavi aged 7 years had problem in passing urine at the age of 1.5 years. She suffered from frequent Urinary tract infection. When diagnosed we came to know she has Non-Neurogenic Neurogenic bladder problem. Her left kidney was already effected due to reflex. So doctor decided to operated her for Vesicostomy. Since then she was on diapers. We did a MCU recently to check if she has improved on bladder control, but she failed. I would like to know if Sacral Nerve Stimulation can be tried on her? if not what is the other option we have?

Category: Pediatric Urologist

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Category: Pediatrician
 22 Doctors Online

Dear Parent,
Thank you for your query at DoctorSpring.com
I can understand your concerns. You must be going through a lot right now. Before I can help you, I need to know certain things.
1. What do you mean by ' non-neurogenic neurogenic bladder' problem? There seems to be some confusion as there is no diagnosis or term such as this one.
2. If she has a neurogenic bladder, she must have been evaluated with urodynamic studies. If you have them, kindly send them across.
3. What is the cause of her bladder dysfunction? Has she had any weakness in lower limbs? Does she have any spinal abnormality or swelling ? Does she have any tightness of lower limbs? Does she have any bowel or stool incontinence?
Kindly answer these queries so that I can help you and guide you.
Regards
Dr. Saptharishi L G


Patient replied :

Hello Doctor, It is infact Neurogenic bladder, but she does not have any spinal abnormalities, no tightness of lowe limbs, she had bowel/stool incontinence initialy for 3 years, for that past 3 years she is passing stool properly. We have not done urodynamic study recently we planning to get it done by this weekend. She is not able to pass urine, her bladder has thickened with only 100 ml capacity. she has undergone Vesicostomy procedure and she is on diapers. MCU done recently shows no refluxes to kidney.
I need an opinion from an pediatric urologist, what next?


Dear parent,

Thank you for answering my queries. Neurogenic bladder is a blanket diagnosis encompassing a wide variety of disorders. It can be due to a variety of neurologic dysfunctions or insults emanating from internal or external trauma, disease, or injury.
Symptoms of neurogenic bladder range from detrusor (bladder muscle wall) underactivity to overactivity, depending on the site of neurologic insult. The urinary sphincter (the door guarding the bladder outlet) also may be affected, resulting in sphincter underactivity or overactivity and loss of coordination with bladder function. The appropriate therapy and a successful outcome can be achieved only through a careful medical and voiding history together with a variety of clinical examinations, including urodynamics and selective radiographic imaging studies.
Kindly get back to me with reports of urodynamic studies. Only then we can decide regarding how much benefit we can expect from alternate therapies ( drugs, sacral nerve stimulation, bladder neck devices, etc)
Regards.


Dr. Purushottam Lal
Category: Pediatrician
Experience: 
Dr. Purushottam Lal and 4 other Medical Specialists are ready to help you

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