Neurogenic Bladder | Diagnosis & Treatments

How we diagnose neurogenic bladder

The first step in treating your child is forming an accurate and complete diagnosis. The symptoms of neurogenic bladder often resemble those of other health conditions, so your child's physician will need to take a complete medical history and do a careful physical examination to rule out other medical issues. Specific diagnostic procedures for neurogenic bladder may include:

  • A urodynamics study: Your child's bladder will be filled with warm saltwater to assess how the bladder and urethral sphincter function during the stages of bladder filling and emptying. At the same time, bladder volume and pressure are measured, as well as the tone or amount of contraction of the bladder. In some instances, urodynamics testing might include an EMG (an electromyogram using needle electrodes) of the sphincter, performed by a neurologist.
  • Radiologic testing: This includes an ultrasound or a voiding cystourethrogram (VCUG), which is an x-ray exam of your child’s bladder and lower urinary tract that uses a special form of x-ray called fluoroscopy. This makes it possible to see internal organs in motion.

After we complete all necessary tests, our experts meet to review and discuss what they have learned about your child's condition. Then we will meet with you and your family to discuss the results and outline the best treatment options.

How we treat neurogenic bladder?

Your child's treatment for neurogenic bladder may include:

  • insertion of a very small catheter, or hollow tube, to empty the bladder at regular intervals
  • antibiotics to prevent urinary tract infection
  • medication to help relax the bladder
  • surgery to enlarge the bladder if it is very small and not responsive to medication
  • surgery to insert an artificial sphincter or a bladder neck sling, both of which can be used to prevent urinary incontinence

In caring for patients affected by neurogenic bladder, what sets Boston Children's apart are innovations in two key areas:

  • Tissue engineering: Typically, surgeons use a patient's intestinal tissue to enlarge the bladder. However, the incompatibility of intestinal tissue and bladder tissue can lead to complications. At Boston Children's, we've pioneered innovations in engineering tissue (growing tissue in the laboratory using the patients' own cells).
    • Using special techniques, our doctors can grow enough of the patient's own bladder tissue to enlarge or replace the bladder.
    • The world's first recipients of tissue augments to enlarge the bladder were at Boston Children's.
    • In conjunction with the Harvard Stem Cell Institute, we are testing the use of embryonic stem cells and induced pluripotent stem (iPS) cells to augment bladder tissue, as well as the use of novel materials, like silk.
  • Urodynamics testing: Our long-standing Neurourology Unit comprehensively evaluates children's lower urinary tract. We offer urodynamics testing in both Boston and Waltham to closely evaluate how the bladder carries out its two main functions: filling and emptying. The results of this testing allows your child's physicians to better diagnose and treat a neurogenic bladder.