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Neurogenic bladder dysfunction in children: Review of pathophysiology and current management
Eduardo T. Fernandes, MD, Yuri Reinberg, MD, Robert Vernier, MD, Ricardo Gonzalez, MD The Journal of Pediatrics Volume 124, Issue 1, Pages 1-7 (January 1994) DOI: /S (94) Copyright © 1994 Mosby, Inc. Terms and Conditions
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Figure. Mechanism of urinary incontinence in children with neurologic deficits. A, Atonic bladder with adequate urethral resistance. Treatment by intermittent catheterization. B, Compliant bladder with good capacity and insufficient urethral resistance. Treatment should increase outlet resistance without diminishing bladder capacity (i.e., implantation of an artificial urinary sphincter with or without intermittent catheterization or fascial sling and intermittent catheterization). C, Incontinence caused by impaired storage capacity of the bladder with adequate urethral resistance. Treatment should be with anticholinergic and smooth muscle-relaxing medications or augmentation cystoplasty. D, Incontinence of mixed origin. If bladder capacity and compliance can be improved with medication, implantation of an artificial urinary sphincter or a fascial sling and intermittent catheterization are sufficient. If an augmentation cystoplasty is required, the options to increase bladder outlet resistance also include bladder neck tubularization procedures (Kropp or Young-Dees Leadbetter). CMG, Cystometrogram; EMG, electromyogram. (From Gonzalez R. Urinary incontinence. In: Kelalis PK, King LR, Belman BA, eds. Clinical pediatric urology. Philadelphia: WB Saunders, 1992: Used by permission.) The Journal of Pediatrics , 1-7DOI: ( /S (94) ) Copyright © 1994 Mosby, Inc. Terms and Conditions
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