Introduction: Cerebral palsy (CP) is a syndrome resulting from perinatal brain injury and is typically characterized by skeletal muscle spasticity. Neurogenic bladder often occurs, with neurogenic detrusor overactivity (NDO) in children and a large capacity, low pressure bladder, with urinary retention from a spastic external sphincter in adults. A catheterizable channel (CC) facilitates clean intermittent catheterization (CIC) while avoiding the spastic sphincter. We previously described de novo NDO (dnNDO) and escalation in therapy for bladder spasticity following CC creation, though with relatively short follow-up. We now provide 5 additional years of experience and compare outcomes in those without dnNDO (dnNDO-neg) and those with dnNDO (dnNDO-pos).
Methods: Retrospective chart review was conducted. Urodynamics, medications, operative interventions, and upper tract imaging were assessed. Fisher’s exact test and t-tests were used for categorical and continuous variables, respectively.
Results: Nine patients underwent CC without augmentation in 2012-2020; mean follow-up was 53 months (range 15-104). There were 4 dnNDO-neg and 5 dnNDO-pos. Patients who developed NDO did so within the first 6-12 months after surgery. Among the dnNDO-neg group, 3 of 4 were on CIC preoperatively and none required escalation of therapy for bladder spasms after surgery. 1 of 5 in the dnNDO-pos group was on regular CIC preoperatively and all 5 required escalation in bladder spasm management after CC: 1 with oral medication, 1 botulinum neurotoxin, 1 an indwelling catheter in her channel for severe incontinence, 1 bladder augmentation, and 1 with severe NDO despite botulinum neurotoxin who is scheduled for bladder augmentation. All have regular renal imaging and none have hydronephrosis. Type of channel, age, preoperative GMFCS score, and use of CIC prior to surgery (p=0.2) were not predictive of dnNDO.
Conclusions: On long-term followup, patients with CP who undergo CC creation without bladder augmentation are at risk of developing dnNDO. In this small study, use of CIC pre-operatively was not predictive of dnNDO. Most patients who develop dnNDO will require invasive management for bladder spasms. Prophylactic bladder augmentation should be considered in this population.