LOWER URINARY-TRACT DYSFUNCTION IN CHILDREN WITH CENTRAL-NERVOUS-SYSTEM TUMORS

The findings in 10 children with neuropathic vesicourethral dysfunctio n after the onset of a central nervous system tumour are presented. Ei ght had a spinal tumour and two a brainstem tumour. Bladder dysfunctio n occurred late in most children except in those with neoplastic infil tration of the conus and cauda equina. Moreover, tumour recurrence was often heralded by loss of bladder control before other neurological s igns became obvious. Videourodynamics (VUD) showed various combination s of ''filling'' and ''voiding'' dysfunction in tumours extending from the pens to the cauda equina, whereas an isolated ''filling'' dysfunc tion was evident in the patient with a suprapontine tumour. Urinary in continence and recurrent urine infection can be immensely distressing to children and their families, particularly when they have had to cop e with the stress of diagnosis and treatment of the underlying tumour. Different management strategies, based on VUD findings, are discussed highlighting the impact these have on the children's quality of life.