Dados do Trabalho

Título

EARLY MANAGEMENT IN NEUROGENIC BLADDER REHABILITATION IN PEDIATRIC POPULATION WITH SPINA BIFIDA

Introdução

Spina bifida is the most common cause of neurogenic bladder in childhood. In the early management of neurogenic bladder, clean intermittent bladder catheterization and/or anticholinergic medication is indicated for up to 3 years or based on initial urodynamic findings when considered high risk for deterioration of the upper urinary tract.

Objetivo

The objective of this study is to verify the benefits of early management of neurogenic bladder related to urological functional results, urinary continence and the need for urological surgical procedures in a pediatric population with spina bifida.

Método

A retrospective longitudinal observational and comparative study was conducted on a cohort of individuals diagnosed with spina bifida, admitted under 1 year of age and currently 16 years or older, treated at the neurogenic bladder clinic of SARAH Brasília. The variables analyzed were the age at first urological investigation, age at the start of neurogenic bladder treatment, age at urological or neurosurgical procedure, age at last urological investigation, urinary continence, and follow-up duration.
A comparative analysis was conducted between the initial and most recent risk classifications up to the study date.

Resultados

The population is made up of 104 cases, with the last consultation between 2021 and 2024. 47% were male, current average age was 18 years old and 96% had myelomeningocele. The average age in the first urodynamic study was 10 months and in the last one, 17 years old. 49% do not walk. 82% of individuals underwent their first urodynamic study before 1 year.

Clean intermittent bladder catheterization was indicated in 94% of the group, regardless of upper urinary tract risk classification. 46% underwent 67 urological procedures. Tethered spinal cord surgery was performed on 21% of children with a mean age of 10 years. The adherence rate to urological treatment was 89% and 46% achieved urinary continence. In the latest urological examinations, 36% were classified as high risk and 64% as low risk for the upper urinary tract. Of the 54 individuals initially classified as high risk, 30 became low risk in the last urological examinations (p = 0.023).

Conclusão

Early management of neurogenic bladder promotes preservation of the urinary tract in children with spina bifida, favors adherence to treatment and reduces urological surgery.

Referências

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Palavras Chave

NEUROGENIC BLADDER REHABILITATION; Spina Bifida; Children