Long-Term Outcomes of Conservative Bladder Management in Pediatric Spina Bifida Patients with Secondary Neurogenic Bladder

A bstract Introduction: Neuropathic bladder is a frequent complication in pediatric spina bifida patients, potentially leading to severe renal damage if left untreated. Effective early management is crucial to preserving renal function and improving patient outcomes. This retrospective cohort study evaluates the medium- and long-term outcomes of conservative management in pediatric patients with spina bifida and secondary NB. Materials and Methods: The study included 50 patients aged 3–12 years, managed between December 2018 and December 2023, with an initial cohort of 70. Conservative interventions, such as clean intermittent catheterization (CIC) and anticholinergic therapy, were prioritized, with bladder augmentation reserved for patients unresponsive to conservative treatment. Primary outcomes were assessed through video urodynamics (UDs) and corrected estimated glomerular filtration rate (eGFR), with secondary outcomes, including continence status and the need for surgery. Results: Out of 70 children with spina bifida and neurogenic bladder (NB), 50 met the inclusion criteria and were analyzed. The follow-up duration ranged from 6 months to 5 years (mean 2 years ± 8 months). A UD evaluation revealed safe bladder patterns in 78% of patients, while 17% had poor compliance and 14% showed elevated detrusor pressures. Serial assessments demonstrated improved bladder compliance and reduced detrusor overactivity. CIC was initiated in 82% of patients, and 64% received anticholinergic therapy. Conservative management was effective in 80% of cases; 18% were managed without CIC. However, 10 patients required bladder augmentation with Mitrafanoff channel due to progressive renal deterioration, and seven underwent surgical drainage. At the final follow-up, 92% maintained normal renal function (eGFR), 15.6% had renal scarring, 3.6% had chronic kidney disease, and 80% of patients achieved social continence. Conclusion: This study supports the use of conservative management for NB in spina bifida, emphasizing the importance of early intervention and regular monitoring to prevent renal deterioration and reduce the need for invasive procedures.