Neurogenic Bladder in Cerebral Palsy: Upper Motor Neuron

Although most children with cerebral palsy can eventually develop total urinary control, more than 50% of them suffer from a spectrum of lower urinary tract symptoms. The severity of urinary symptoms depends on the extent of motor, mental, cognitive, and neurological disabilities associated with cerebral palsy. While routine urological evaluation in children with cerebral palsy is not indicated as in the case in children with spinal dysraphism, physicians who care for children with cerebral palsy should be familiar with urological manifestations of the disorder and refer children with voiding complaints for urological work up. Common lower urinary tract complaints in children with cerebral palsy include delay in toilet training, urinary incontinence, urinary frequency, urgency, hesitancy in voiding, incomplete emptying, and recurrent urinary tract infections. Urodynamic studies in select cerebral palsy patient populations demonstrate detrusor overactivity, reduced bladder capacity, detrusor-sphincter dyssynergy, and rarely impaired bladder compliance and upper urinary tract deterioration. In this chapter, we discuss the physiology of bladder function, urological presentations, diagnostic work up, and management of children with cerebral palsy.