THE NONNEUROGENIC NEUROGENIC BLADDER OF EARLY INFANCY

Purpose: The nonneurogenic neurogenic bladder has traditionally been b elieved to represent a disorder of older children. We report on patien ts in whom congenital dysfunctional voiding may be the underlying caus e of nonneurogenic neurogenic bladder in early infancy. Materials and Methods: We evaluated 5 male and 2 female patients newborn to 30 month s old with dysfunctional neurogenic bladder and no evidence of neurolo gical pathology or anatomical outflow obstruction. Presentation includ ed prenatal hydronephrosis in 3 cases, urosepsis in 2 and failure to t hrive in 2. Radiological and urodynamic investigations revealed thick walled, poorly compliant bladders in 5 patients and incomplete bladder emptying bordering on urinary retention in 2. There was significant u pper tract pathology in all cases, including azotemia in 4, reflux in 4 and hydroureteronephrosis in 6. Due to poor bladder function, manife sted by incomplete emptying or high storage pressures, all patients we re initially treated with cutaneous vesicostomy. Results: Bladder appe arance and function subsequently improved in 3 patients and vesicostom y was reversed. Three patients with persistently thickened bladders, i ncluding 2 with renal failure, underwent bladder augmentation. The rem aining patient had improved bladder storage function but requires inte rmittent catheterization. Conclusions: The nonneurogenic neurogenic bl adder represents a rare, severe form of dysfunctional voiding that may be present even in the neonatal period.