[Neuropathic bladder dysfunction]

The knowledge that after closure of the spinal cord defect, function of pelvic floor can change from hypocontractility to overactivity within the first months of life, is very important for successful treatment. All newborns at that time have residual urine after a spontaneous void. The most authors therefore recommend to start all newborns on intermittent catheterisation every 3 hours. The pattern of bladder dysfunction (Sillen 1996) changes within the first year of life towards moderate or severe overactivity with accompanying bladder-sphincter dyssynergy. Bauer (2000) observed that 14% of children with synergy initially deteriorated due to a conversion to dyssynergy, 30% of infants with absent sphincter activity in the beginning developed reflux or hydronehrosis due to denervation fibrosis of the external sphincter and high outlet resistance. One third of these changes were seen before one year of age, but 82% before age two. From these reasons highly beneficial is immediately, after closure of spinal cord defect, to perform ultrasound examination with calculation of residual urine and urodynamic evaluation. It clearly proves the beneficial role of anticholinergics and CIC with 63% of refluxes treated successfully. In patients whose reflux resolved bladder volume and bladder compliance improved and leak point pressure was markedly reduced.