Pediatric Urology and Spina Bifida Patients

Children with spina bifida receive treatment for urological conditions. The CHOC Urology Center’s team of specialists focus on the bowel and bladder functions of spina bifida patients, as well as the safety of their urinary tract (kidneys, ureters, bladder and urethra) using ultrasounds, VCUGs and video urodynamics. The most common diagnoses in spina bifida patients include hydronephrosis, urinary tract infections and vesicoureteral reflux. They may also have difficulty or be unable to void independently due to nerve damage that causes malfunctioning bladders and bowels and possible retention. This is called neurogenic bladder and bowel.

Most children with spina bifida begin clean intermittent catheterization (CIC) shortly after birth to assist them in emptying their bladder completely. CIC relieves urinary retention and keeps the bladder and the kidneys at a low pressure thus reducing the chances of damage to the urinary tract. It is common for children to begin taking medication directly after birth to help relax the bladder muscle. Most children with spina bifida within the clinic will remain on CIC and medication treatment while being seen in our clinic. Some children will additionally need to keep a catheter in their bladder overnight. These catheters have a small balloon on them to allow the bladder to remain in the bladder, they are called foley catheters.

Children who have recurrent urinary tract infections may be placed on behavioral modifications, prophylactic antibiotics or gentamicin washes for their bladders.

Some children will require surgeries during their childhood to help relieve complications that arise. Some of the more common urological surgeries completed in children with spina bifida are:

• Bladder augment: A surgery using a portion of the intestines (occasionally other tissues may be used instead) to enlarge the size of a bladder. Following bladder augments a child and their family will be instructed on how to irrigate their augment to reduce their changes of urinary tract infections and reduce the amount of mucous produced. Learn more about irrigating the bladder.
• Vesicostomy: A surgery to create an opening in the abdomen from the bladder that allows urine to freely drain.
• Mitrofanoff: A surgery to create a catherizable channel in the abdomen to allow for catheterization of the bladder to empty urine.
• ACE/ MACE: A surgery to create a continent outlet for a catheter or enema insertion to allow for evacuation of stool from the large intestines.

Parents and guardians of children with spina bifida may be asked to perform a number of different procedures to assist their children with their urinary tract needs. Click here for the forms and instructions that may be helpful for families.