Neuropathic Bladder

Question 1

bladder capacity

Answer 1

The normal expected bladder capacity up to the age of 12 is calculated as (age + 1) x 30 mL (4-12 years)
Normal daytime voided volumes are usually 65–150% of expected bladder capacity
other formula 0-2 years 0.75 x weight in kg

Question 2

residual volume

Answer 2

• PVR greater than 20mls or more than 10% bladder capacity can be seen as elevated in 4-6 years
• In 7-12 years repetitive PVR more than 10mls or 6% BC can be defined as elevated

Question 3

occult spina bifida skin sign

Answer 3

40% with atypical presacral dimples found to have occult spinal dysraphism

Atypical dimple is one that is off centre
more than 2.5cm from anal verge at birth
or deeper than 0.5cm

May have sacral hair tuft, haemangioma, tail, lipoma, port wine stain

Recommend MRI for any sacral dimple that is > 5mm in depth > 25mm from anus 
Covered by hair 
Base not visualised
With other cutaneous stigmat
Or with abnormal neurology.

Question 4

compliance per 100mls water infused

Answer 4

 Allowed to have increase of 1cm H2O for every 40mls infused up to 400mls capacity
 Or around 2.5cm H2O for every 100mls infused

Question 5

initial management neonate SB

Answer 5

Refer to urology within 24 hours
All patients get urethral catheter to facilitate back closure and no leakage of urine onto back
Leave for 7-10 days
US to get baseline for upper tracts
Urology review – look for anocutaneous reflex
Catheter removed by nurses at 7-10 following back closure
Emptying – if doing this nothing else
If large residual start CISC at that point
Nappy alarm – song every time passes urine then scan bladder for PVR, do for four hours, normal infant bladder cycle, check can pee once during 4 hours, do this 7-10 days post op and once more in clinic
Neuro –uro joint clinic, urologist, UDS nurse specialist, neurosurgeons, neurosurgeon nurse specialist, physiotherapist, SHINE charity reps, also linked in with orthopaedics
6 weeks post discharge – second bladder assessment with nappy alarm and post void residuals

Question 6

bladder capacity under 12 month

Answer 6

weight x 10

Question 7

normal number times void
neonate
1-2
2-4

Answer 7

30 times
20 times
5-10x