Lesions at any level in the nervous system are the most common causes of congenital Neurogenic Detrusor
Overactivity (NDO). This condition is considered as a lack of bladder control that can increases the risk to
develop chronic pyelonephritis and consequently to Chronic Kidney Disease (CKD).
The main purposes of a correct management are preventing urinary tract deterioration, improving continence
and Quality Of Life (QOL). (1)
The primary objects of this study are the preservation of renal function, the achievement of an acceptable
continence and the improvement of the QOL. These results are achieved with an early proactive approach,
starting from the first days of life. Intermittent Catheterization (IC) in combination with anticholinergic
(oxybutynin at dosage 0.2-0.4 mg/kg weight per day) are the first line treatment (2). In case of patients with
insufficient response or significant side effects to anticholinergic (oral or intravesical instillation) therapy,
Botulinum toxin-A injection into detrusor is a possible alternative. Therefore it is not infrequent that individuals
with NDO present also Neurogenic Bowel (NB). This medical situation causes constipation or incontinence
and can be prevented by Transanal Irrigation (TAI), which is performed in most of our patients. When the
conservative approach fails, surgery has to be valued. We reported our experience to show the outcome in
patients with NDO due to Neural Tube Defects (NTDs) treated medically.

This is a single-center retrospective study. In a four-year period (2016-2019) 62 patients with NTD were
observed and 28 patients with NDO and NB due to NTD were studied: 12 patients aged from 3 to 17 years
old and 18 patients aged from 19 to 49 years old. There were no gender difference. 34 patients were
excluded from our study for lacking of compliance, for having left the follow up or for having had a surgery.
Diagnosis was confirmed by Voiding-Cysto-Urethrography (VCUG) and urodynamic study.
Sex, age, creatinine, Glomerular Filtration Rate (GFR), number of IC/die, number of TAI/die, oral
administration of Polyethylene Glycol (PEG) solutions, Urinary Tract Infections (UTI) and continence were
analyzed by a descriptive statistics.
Creatinine Clearance was estimated using the original Schwartz method for pediatric patients and CKD-EPI
(Chronic Kidney Disease Epidemiology Collaboration) equation were used to estimate GFR in young adult
patients (3).
Good quality of life was evaluated indirectly conducting a survey about continence and satisfaction.
In conclusion, we considered GFR>80 mL/min per 1.73 m² as a quite appropriate kidney function.

Concerning the pediatric group, all children but 2 are treated with CIC (83,3%) and 9 of them are treated with
TAI (75%).
7 children (58,3%) use to take PEG solutions daily.
2 out of 12 (16,6%) result anal and urinary incontinent but they refuse to take PEG solutions and do not
perform TAI regularly.
Most but 3 (75%) do not report recurrent UTI.
All children (100%) have GFR>80 mL/min per 1.73 m².
Among 18 adult patients, all (100%) are treated with CIC, and 12 (66%) performed TAI too.
Moreover, only 4 in the adults group (33,3%) use to take regularly PEG solutions.
Most but 2 (89%) do not report recurrent UTI and only 3 young adults (16,6%) are incontinent despite
treatment.
The majority (94,4%) have GFR>80 mL/min per 1.73 m².

According to the results 96,6% of our patients have a good kidney function and the majority of children
achieve social continence or a significant improvement with CIC and TAI treatment:
CIC seems to reduce the risk of urinary tract infections and overdistension of the bladder and TAI seems to
improve bowel disturbances.
None of them has reported recurrent UTI episodes.
From this follows a high parental satisfaction and, currently, it can be affirmed that all of our patients do not
need surgical treatment.

Neurogenic Detrusor Overactivity due to NTD could cause incontinence and urinary stasis, with recurrent
urinary tract infections and progressive deterioration of the upper urinary tract.
In our experience, conservative treatment and careful follow up represent a safe approach and is
recommended as soon as possible in order to preserve renal function.

Le, H.-K., Cardona-Grau, D., & Chiang, G. .Evaluation and Long-term Management of Neurogenic Bladder in Spinal Dysraphism. NeoReviews, 2019 Dec;20(12):e711-e724.
Stein Raimund, Guy Bogaert, Hasan S. Dogan, Lisette Hoen, Radim Kocvara, Rien J. M. Nijman, Josine S. L. T. Quadackers,Yazan F. Rawashdeh, Mesrur S. Silay, Serdar Tekgul, Christian Radmayr. EAU/ESPU guidelines on the management of neurogenic bladder in children and adolescent part I diagnostics and conservative treatment. Neurourol Urodyn 2020 Jan;39(1):45-57.
Larijani FJ, Moghtaderi M, Hajizadeh N, Assadi F. Preventing kidney injury in children with neurogenic bladder dysfuncionInt J Prev Med. 2013 Dec;4(12):1359-64.