Cerebral palsy incontinence likely due to underlying pathology

April 1, 2008

Video urodynamic studies found serious underlying pathology in a majority of cerebral palsy children who had urinary incontinence.

"Urinary incontinence is a very common finding in children with CP," said Andrew Combs, RPA-C, director of pediatric urodynamics at the Morgan Stanley Children's Hospital of New York Presbyterian. "The problem is that many clinicians rarely give it more than a cursory evaluation. Our patients with CP had more voiding pathology than expected, based on generally held beliefs."

In this small population, 18 patients (82%) had hyperreflexia and one (4.5%) had hypocontractility. Sixteen of the patients (73%) had signs of significant bladder or upper urinary tract insult. Problems included grades III to V reflux (27%) associated with urinary tract infection and detrusor-sphincter dyssynergia, diverticula (23%), severe loss of compliance (27%), renal failure (4.5%), and detrusor decompensation (14%). Only six (38%) of the patients had any previously identified bladder or renal injury.

"This paper says that a lot of us may not have completely evaluated children with disabilities," said Patrick McKenna, MD, professor and chair of urology at Southern Illinois University School of Medicine, Springfield. "Many of these children have treatable conditions. I have certainly begun to rethink the ways I manage more severely handicapped patients."

Dr. McKenna said that many physicians see impaired mentation, impaired movement, or other handicaps associated with neurologic disease and assume that physical problems such as incontinence cannot be treated because the patients do not have the mental maturity to participate in their care. This leads some clinicians to believe that further evaluation is unnecessary until the mental age reaches a certain level.