Neurogenic disorders of bladder emptying in childhood

The treatment of neurogenic bladder dysfunction must be aimed at the protection of the upper urinary tract through complete bladder emptying and normalization of intravesical bladder pressures in rest and during voiding. Nowadays also urinary continence should be restored in childhood. Based on the urodynamic classification modified by Madersbacher the current treatment strategies are presented. Individual pharmacotherapy, especially pharmacological transformation of detrusor hyperreflexia into hyporeflexia and clean intermittent catheterization are the main conservative therapeutic tools. In special cases bladder augmentation, cutaneous vesicostomy and artificial sphincter devices are the method of choice, while bladder substitution should be performed as a last resort.