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Nonneurogenic Neurogenic Bladder

6 months old girl presented with difficulty in passing urine, straining and urinary infections.
Clinical examination was normal and urine examination showed features of infection. Ultrasonogram showed mild swelling of left kidney. After the infection was treated with antibiotics, the child underwent a Micturating Cystourethrogram (MCU, also called Voiding Cystourethrogram or VCUG).
VCUG showed small capacity, trabeculated bladder with left grade 4 reflux and a non-relaxing bladder neck. She was prescribed bladder relaxants, drugs to relax the bladder neck and low dose antibiotics. Her symptoms gradually disappeared and she has remained free of infections over last 5 months.
Plan is to do a VCUG again at 1.5 years of age to assess if she requires surgery.

This condition is called - Non-neurogenic Neurogenic bladder of infancy and is very rare. It needs an individualized approach with fine tuning of medicines based on the individual's condition. 

Fig 1: MCU showing small capacity bladder, left VUR and non relaxing bladder neck

 

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