From the Guidelines
The treatment for thoracic syrinx with neurogenic bladder should prioritize a multidisciplinary approach, including surgical intervention for the syrinx and pharmacological management of bladder dysfunction, with a focus on preserving renal function and improving quality of life.
Key Components of Treatment
- Surgical intervention for the syrinx, such as suboccipital decompression with or without duraplasty, depending on the underlying cause 1
- Pharmacological management of neurogenic bladder, including anticholinergic medications like oxybutynin (0.2 mg/kg orally given 3 times daily) for detrusor overactivity, as indicated by urodynamic evaluation 1
- Clean intermittent catheterization (CIC) performed 4-6 times daily for bladder emptying if retention is present, which is considered the gold standard for treating voiding disorders associated with neurogenic bladder 1
- Regular urodynamic testing and renal function monitoring to prevent upper urinary tract damage, with consideration of beta-3 agonists like mirabegron or botulinum toxin injections for refractory cases
Considerations for Renal Function
- Patients with neurogenic bladder due to central nervous system disorders are at risk of renal failure, with approximately 26% of patients with spina bifida developing renal failure 1
- Regular review of clinical history, physical examination, US, and urodynamic studies are key components of initial diagnosis and ongoing management 1
Quality of Life
- Physical therapy focusing on pelvic floor exercises can help improve continence and overall quality of life
- A comprehensive treatment plan should aim to address the mechanical compression of the spinal cord from the syrinx, while pharmacologically managing the disrupted neural control of bladder function, to ultimately preserve renal function and improve quality of life 1
From the FDA Drug Label
Oxybutynin chloride is indicated for the relief of symptoms of bladder instability associated with voiding in patients with uninhibited neurogenic or reflex neurogenic bladder (i.e., urgency, frequency, urinary leakage, urge incontinence, dysuria). The treatment for thoracic syrinx with neurogenic bladder may include oxybutynin to relieve symptoms of bladder instability, such as:
- Urgency
- Frequency
- Urinary leakage
- Urge incontinence
- Dysuria 2
From the Research
Treatment Options for Thoracic Syrinx with Neurogenic Bladder
- The treatment for thoracic syrinx with neurogenic bladder involves a multidisciplinary approach, including urology and rehabilitation specialists 3.
- Patients with neurogenic bladder should be offered help to better understand the disorder and taught how to use treatment techniques to obtain satisfactory results and promote their autonomy 3.
- Mirabegron, a β3-adreceptor agonist, has been shown to be effective as an adjuvant treatment in children with refractory neurogenic bladder dysfunction, increasing bladder capacity and reducing intravesical pressure 4.
- Intravesical oxybutynin hydrochloride has been used to treat patients with neurogenic bladder managed by intermittent catheterization, with some patients experiencing subjective improvement and increased bladder capacity 5, 6.
Medication and Therapy
- Mirabegron has been found to be safe and well-tolerated in children, with over 70% of incontinent patients becoming dry after administration 4.
- Intravesical oxybutynin hydrochloride has been shown to be effective in patients with overactive detrusor, but not in those with underactive detrusor and low urethral closure pressure 5.
- Oral anticholinergic agents and intermittent catheterization are also commonly used to manage neurogenic bladder 3, 6.
Syringomyelia and Neurogenic Bladder
- A syrinx, a fluid-filled cavity within the spinal cord, can cause neurogenic bladder, which is a condition where a person has trouble with bladder control due to a brain, spinal cord, or nerve problem 7.
- Reversible urinary retention can be a symptom of syringomyelia, and neurogenic bladder is seldom described as the first manifestation of the condition 7.