INTRAVESICAL BLADDER STIMULATION IN PEDIATRIC PATIENTS WITH SPINAL CORD DEFECTS

Background: Creating a low pressure continent urinary storage mechanism for the pediatric patient with a neurogenic bladder is a difficult problem. The current answer, enterocystoplasty with intermittent catheterization, is not an ideal solution. In an effort to optimize storage we used intravesical electro-bladder stimulation for patients with spinal cord defects. Methods: A retrospective review of all pediatric patients with neurogenic bladders undergoing bladder stimulation was performed. Indications and goals of treatment were noted. Bladder stimulation was performed in the manner previously described by Kaplan. Parameters reviewed included patient age, initial age adjusted pressure specific ([is less than] 30cm [H.sub.2]O) bladder volume (%PSBV), initial random urinary residual, number of treatments, number of sessions per treatment, follow-up %PSBV, voiding and continence status. Results: Records were reviewed for all 44 patients treated. Initial age at initiation of therapy was 6.6 years. Indications included decreasing bladder storage pressures (n=24), increase continence between caths (n=13) and achieving volitional voiding (n=7). The first sessions averaged 18 treatments, the second 8.5, the third 7.6 and the fourth, 7.4 treatments. Indication N Initial Final PSBV% PSBV% Dec. Storage 24 0.48 [+ or -] 0.07 0.54 [+ or -] 0.06 Pressure Dry between 13 0.58 [+ or -] 0.09 0.71 [+ or -] 0.1 cath. Volitional 7 0.9 [+ or -] 0.2 0.8 [+ or -] 0.2 voiding Indication # % Achieving Achieving Goal Goal Dec. Storage 3 13% Pressure Dry between 1 8% cath. Volitional 0 0% voiding Patients who became dry had similar age at initiation of treatment, bony defect level, initial capacity and PVR, and number of treatments compared to non-responders. Non-responders required surgical intervention to achieve continence with safe storage pressures. One patient became incontinent after undergoing treatment to achieve volitional voiding. Conclusion: While some high-risk patients were spared surgery with intravesical electro-bladder stimulation, most were not. Spontaneous voiding to completion, at safe pressures, was not achieved in this group of patients. We were unable to clarify, prior to treatment, which patients would benefit from this labor-intensive therapy. Jeff L. Pugach, M.D., Louisa Salvin, R.N. Virginia Stalnaker, R.N. George F. Steinhardt, M.D., F.A.A.P. St. Louis University, Cardinal Glennon Children's Hospital. St. Louis, MO (Presented by Dr. Pugach)3