Endoscopic approach to urinary incontinence in pediatric neurogenic bladder dysfunction

Urinary continence is still a difficult goal to achieve in neurogenic bladder patients. In pediatric age, urinary incontinence is mostly caused by congenital abnormalities, whereas the acquired causes are less frequent. Congenital anatomical defects are common in pediatric patients, such as exstrophy-epispadias complex, extravesical ectopic ureter in females, and urethral duplication. Functional disorders of the lower urinary tract are frequently responsible of incontinence. Neurogenic bladder is usually the consequence of spina hifida (meningomyelocele), sacral agenesis, and other congenital abnormalities of the spina. Less frequently in children, neurogenic bladder can he the consequence of acquired lesions, such as spinal trauma and myelitis [1-4]Classically, the functional classification of urinary incontinence has two mains groups of pathogenetic mechanisms: the failure of storage and the failure to empty [2] The storage activity of the lower urinary tract can bc failed as conscqucnce of increased dctiusor contractility or decreased outlet resistance (Table 1). The failure to empty the urinary reservoir is a possible consequence of decreased detrusor musculature contractility or increased outlet resistance ('lable 1). In pediatric age, the congenital causes are more frequent and may be neurogenic, as in the neuropatic bladder due to of spinal dysraphism or sacral agenesis, or congenital anatomical defects (epispadias-exstrophy complex, urogenital sinus, etc).