Lower urinary tract dysfunction in pediatrics progress to kidney disease in adolescents: Toward precision medicine in treatment

Abstract

Newborn infants who had neurogenic bladder dysfunction (NBD) have a normal upper urinary tract at birth. Most of them will develop deterioration of renal function and chronic kidney disease if they do not receive proper management. Children with NBD can develop renal damage at adolescence or earlier, which is due to high detrusor pressures resulted from poor compliance of the bladder, detrusor overactivity against a closed sphincter or detrusor sphincter dyssynergia. To preserve renal function and prevent deterioration of the kidneys, NBD must be treated immediately after being diagnosed. Over the last few years there was great progress in the treatment of children with the NBD. We searched PubMed and the Cochrane Library for peer-reviewed articles published in any language up to March 10, 2021, using the search term “neurogenic bladder children.” Our search excluded diagnosis, pathophysiology, surgical treatment of spinal cord injury and spina bifida. The research identified the effectiveness of treatment regimens targeting prevention of chronic kidney disease and the indications of kidney transplantation. The results of the research showed that NBD in children should be diagnosed early in life, and the child should receive the proper management. The literature search concluded that the management of NBD in children would be personalized for every case and could be changed according to response to treatment, side effects, child compliance, availability of treatment modality and costs of treatment. The objectives of the study are to present the different options of management of NBD in children and the selection of the proper method in a personalized manner.

Keywords: Neurogenic bladder dysfunction; Antimuscarinics; Onabotulinum toxin A; Neural stimulations; Renal transplantations

Core Tip: Neurogenic bladder dysfunction in children can lead to renal dysfunction and chronic kidney failure. This review reports treatment options including the latest modalities. The new anti-muscarinic drugs have minimal adverse effect, high tolerability, availability of solution form and dose adjustment. Children who develop adverse events from anti-muscarinics or non-compliant to clean intermittent catheterization would be candidate for detrusor muscle injection with onabotulinum toxin A, which proved to be safe with no adverse effects. Kidney transplantation would be the last resort for treatment after progressive deterioration of kidney function.