# Neurogenic Bladder — GCMD Library living collection

Everything in the library about neurogenic bladder — built automatically from dossiers that name it.

Updated: n/a · 3 episodes · 61 cited statements

## Episodes
### Complications
- [Cloaca - Urologic Concerns](https://qa.library.globalcastmd.com/watch/cloaca-urologic-concerns-681) — video · 25:29 · [machine version](https://qa.library.globalcastmd.com/watch/cloaca-urologic-concerns-681.md)

### Evidence & Research
- [Association Between Social Determinants of Health and Choice of Urinary Reconstruction in Children](https://qa.library.globalcastmd.com/watch/association-between-social-determinants-of-health-and-choice-of-urinary-reconstr-12168) — video · 1:22 · [machine version](https://qa.library.globalcastmd.com/watch/association-between-social-determinants-of-health-and-choice-of-urinary-reconstr-12168.md)

### In-Depth Reviews
- [Neurogenic Bladder](https://qa.library.globalcastmd.com/watch/neurogenic-bladder-2897) — podcast · 55:25 · [machine version](https://qa.library.globalcastmd.com/watch/neurogenic-bladder-2897.md)

## Chapters
- [0:00](https://qa.library.globalcastmd.com/watch/cloaca-urologic-concerns-681?t=0) Urologic Risk Stratification and Management Framework for Cloacal Malformations (Ep 1)
- [16:52](https://qa.library.globalcastmd.com/watch/cloaca-urologic-concerns-681?t=1012) Suprapubic Tube vs. Vesicostomy Decision-Making (Ep 1)
- [18:58](https://qa.library.globalcastmd.com/watch/cloaca-urologic-concerns-681?t=1138) Dr. Pena's Philosophy on Postoperative Bladder Drainage (Ep 1)
- [20:23](https://qa.library.globalcastmd.com/watch/cloaca-urologic-concerns-681?t=1223) High-Risk Patients for Renal Transplantation (Ep 1)
- [21:54](https://qa.library.globalcastmd.com/watch/cloaca-urologic-concerns-681?t=1314) Mitrofanoff and Malone Timing and Coordination (Ep 1)
- [0:04](https://qa.library.globalcastmd.com/watch/neurogenic-bladder-2897?t=4) Introduction and scope of neurogenic bladder in pediatric populations (Ep 2)
- [2:34](https://qa.library.globalcastmd.com/watch/neurogenic-bladder-2897?t=154) Initial evaluation of the newborn with myelomeningocele (Ep 2)
- [9:37](https://qa.library.globalcastmd.com/watch/neurogenic-bladder-2897?t=577) Indications and timing for clean intermittent catheterization (Ep 2)
- [15:33](https://qa.library.globalcastmd.com/watch/neurogenic-bladder-2897?t=933) Counseling families and multidisciplinary care (Ep 2)
- [20:38](https://qa.library.globalcastmd.com/watch/neurogenic-bladder-2897?t=1238) Surveillance intervals and adjunctive anticholinergic therapy (Ep 2)
- [25:05](https://qa.library.globalcastmd.com/watch/neurogenic-bladder-2897?t=1505) Management of persistent high bladder pressure and indications for vesicostomy (Ep 2)
- [31:52](https://qa.library.globalcastmd.com/watch/neurogenic-bladder-2897?t=1912) Urinary tract reconstruction for continence: augmentation, bladder neck procedures, and catheterizable channels (Ep 2)
- [46:01](https://qa.library.globalcastmd.com/watch/neurogenic-bladder-2897?t=2761) Botox as a minimally invasive alternative to reconstruction (Ep 2)
- [48:24](https://qa.library.globalcastmd.com/watch/neurogenic-bladder-2897?t=2904) Transition to adult care: challenges and unmet needs (Ep 2)
- [52:53](https://qa.library.globalcastmd.com/watch/neurogenic-bladder-2897?t=3173) Key clinical takeaways and closing (Ep 2)
- [0:00](https://qa.library.globalcastmd.com/watch/association-between-social-determinants-of-health-and-choice-of-urinary-reconstr-12168?t=0) Study Design and Population (Ep 3)
- [0:31](https://qa.library.globalcastmd.com/watch/association-between-social-determinants-of-health-and-choice-of-urinary-reconstr-12168?t=31) Key Findings (Ep 3)
- [0:54](https://qa.library.globalcastmd.com/watch/association-between-social-determinants-of-health-and-choice-of-urinary-reconstr-12168?t=54) Clinical Implications (Ep 3)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- The study was a single institution retrospective study of 208 patients with neurogenic bladder, anorectal malformations, myelomeningocele, and other spinal cord pathology who underwent urinary reconstruction between 2014 and 2021 — Megan Reedy Vituri (epidemiological) [Ep 3 · 0:11](https://qa.library.globalcastmd.com/watch/association-between-social-determinants-of-health-and-choice-of-urinary-reconstr-12168?t=11)
- About 74% of patients underwent continent reconstruction and 26% underwent incontinent reconstruction — Megan Reedy Vituri (epidemiological) [Ep 3 · 0:32](https://qa.library.globalcastmd.com/watch/association-between-social-determinants-of-health-and-choice-of-urinary-reconstr-12168?t=32)
- There was no difference in reconstruction type based on insurance type — Megan Reedy Vituri (epidemiological) [Ep 3 · 0:38](https://qa.library.globalcastmd.com/watch/association-between-social-determinants-of-health-and-choice-of-urinary-reconstr-12168?t=38)
- There was no difference in reconstruction type based on childhood opportunity index — Megan Reedy Vituri (epidemiological) [Ep 3 · 0:38](https://qa.library.globalcastmd.com/watch/association-between-social-determinants-of-health-and-choice-of-urinary-reconstr-12168?t=38)
- Patients who had incontinent reconstruction were more likely to have food insecurity — Megan Reedy Vituri (epidemiological) [Ep 3 · 0:38](https://qa.library.globalcastmd.com/watch/association-between-social-determinants-of-health-and-choice-of-urinary-reconstr-12168?t=38)
- Patients who had incontinent reconstruction were more likely to have missed appointments — Megan Reedy Vituri (epidemiological) [Ep 3 · 0:38](https://qa.library.globalcastmd.com/watch/association-between-social-determinants-of-health-and-choice-of-urinary-reconstr-12168?t=38)
- Patients who had incontinent reconstruction were more likely to have unmarried parents — Megan Reedy Vituri (epidemiological) [Ep 3 · 0:38](https://qa.library.globalcastmd.com/watch/association-between-social-determinants-of-health-and-choice-of-urinary-reconstr-12168?t=38)
- Patients who traveled from out of state were more likely to have a continent diversion — Megan Reedy Vituri (epidemiological) [Ep 3 · 0:49](https://qa.library.globalcastmd.com/watch/association-between-social-determinants-of-health-and-choice-of-urinary-reconstr-12168?t=49)
- Social stability and the ability to engage with follow-up may be influencing what surgeons offer families as well as what families can realistically manage — Megan Reedy Vituri (opinion) [Ep 3 · 0:57](https://qa.library.globalcastmd.com/watch/association-between-social-determinants-of-health-and-choice-of-urinary-reconstr-12168?t=57)
- The best reconstruction isn't just one that's technically feasible, it also needs to be sustainable for patients and their families — Megan Reedy Vituri (opinion) [Ep 3 · 1:08](https://qa.library.globalcastmd.com/watch/association-between-social-determinants-of-health-and-choice-of-urinary-reconstr-12168?t=68)
- Preoperative and postoperative urodynamic studies in cloaca patients with common channel <2 cm repaired via posterior sagittal approach have not demonstrated very deleterious effects. (clinical) [Ep 1 · 0:00](https://qa.library.globalcastmd.com/watch/cloaca-urologic-concerns-681?t=0)
- Cloacas are the highest-risk patients among anorectal malformation patients for bladder dysfunction. (opinion) [Ep 1 · 0:00](https://qa.library.globalcastmd.com/watch/cloaca-urologic-concerns-681?t=0)
- In the speaker's institutional cohort of cloaca patients (mean age 4.5 years), almost half had CKD stage 2 or 3 (GFR 30-90 mL/min). (epidemiological) [Ep 1 · 0:00](https://qa.library.globalcastmd.com/watch/cloaca-urologic-concerns-681?t=0)
- In a study of 44 cloaca patients at the speaker's institution (mean common channel 4 cm, high percentage with neurogenic bladder on active management), none showed CKD stage progression over mean 5-year follow-up. (epidemiological) [Ep 1 · 0:00](https://qa.library.globalcastmd.com/watch/cloaca-urologic-concerns-681?t=0)
- Vesicostomy is not the speaker's first choice for bladder drainage; preference is to keep bladder closed rather than create vesicostomy where capacity and management can be more difficult. (opinion) [Ep 1 · 17:14](https://qa.library.globalcastmd.com/watch/cloaca-urologic-concerns-681?t=1034)
- Vesicostomy may be indicated in cases with solitary renal unit, massively dilated renal unit or hydroureter, or intraoperative concerns about urethral viability for catheterization or voiding. (clinical) [Ep 1 · 17:14](https://qa.library.globalcastmd.com/watch/cloaca-urologic-concerns-681?t=1034)
- For cloaca patients with common channel 2 cm, normal sacrum, no tethered cord, and uncomplicated repair, Dr. Pena leaves only a Foley catheter (not suprapubic) for 2-3 weeks, expecting the patient will void spontaneously after removal. — Pena (clinical) [Ep 1 · 18:58](https://qa.library.globalcastmd.com/watch/cloaca-urologic-concerns-681?t=1138)
- For more complicated cloaca cases (common channel ≥3 cm, tethered cord, abnormal sacrum), Dr. Pena uses suprapubic tube to enable urodynamic studies and avoid nighttime voiding emergencies. — Pena (clinical) [Ep 1 · 18:58](https://qa.library.globalcastmd.com/watch/cloaca-urologic-concerns-681?t=1138)
- For patients with very poor bladder, mega-ureter, single kidney, hydronephrosis, and reflux, Dr. Pena considers vesicostomy necessary. — Pena (clinical) [Ep 1 · 18:58](https://qa.library.globalcastmd.com/watch/cloaca-urologic-concerns-681?t=1138)
- Database review at Cincinnati Children's identified high-risk group for kidney transplant: patients with kidney failure at birth, ectopic ureters, cloaca, and strictured common channel. — Andrea (epidemiological) [Ep 1 · 20:51](https://qa.library.globalcastmd.com/watch/cloaca-urologic-concerns-681?t=1251)
- Mitrofanoff is not performed at time of primary cloaca repair; it is done at older age when fecal incontinence and bowel management needs are clearer (toilet-training age). (clinical) [Ep 1 · 21:54](https://qa.library.globalcastmd.com/watch/cloaca-urologic-concerns-681?t=1314)
- When both Mitrofanoff and Malone are needed, the appendix can potentially be divided if vascular anatomy and length permit, allowing use for both procedures. (clinical) [Ep 1 · 21:54](https://qa.library.globalcastmd.com/watch/cloaca-urologic-concerns-681?t=1314)
- Some U.S. centers place Malone antegrade continence enema at time of colostomy closure, but the speaker's institution waits to assess laxative response first, as Dr. Pena has seen successful laxative management in cases where he had zero confidence. (clinical) [Ep 1 · 21:54](https://qa.library.globalcastmd.com/watch/cloaca-urologic-concerns-681?t=1314)
- The speaker proposes lower-risk cloaca category: common channel <2 cm, normal spinal cord, no structural anomalies, primary repair. (opinion) [Ep 1 · 0:00](https://qa.library.globalcastmd.com/watch/cloaca-urologic-concerns-681?t=0)
- The speaker proposes higher-risk cloaca category: common channel >3 cm, abnormal spinal cord, structural anomalies (solitary kidney, hydrocolpos), reoperative surgery. (opinion) [Ep 1 · 0:00](https://qa.library.globalcastmd.com/watch/cloaca-urologic-concerns-681?t=0)
- Annual surveillance for cloaca patients should include renal ultrasound and history up until toilet training age. (guideline) [Ep 1 · 0:00](https://qa.library.globalcastmd.com/watch/cloaca-urologic-concerns-681?t=0)
- Blood pressure measurement is important in cloaca follow-up because hypertension can be a manifestation of chronic kidney disease. (clinical) [Ep 1 · 0:00](https://qa.library.globalcastmd.com/watch/cloaca-urologic-concerns-681?t=0)
- Measuring serum creatinine alone is insufficient; glomerular filtration rate should be calculated using formulas that incorporate patient weight, height, and creatinine. (clinical) [Ep 1 · 0:00](https://qa.library.globalcastmd.com/watch/cloaca-urologic-concerns-681?t=0)
- VCUG and urodynamics should be reserved for select cloaca patients; shorter common channel cases with normal renal ultrasounds and no concerning history may reasonably omit these studies in routine follow-up. (opinion) [Ep 1 · 0:00](https://qa.library.globalcastmd.com/watch/cloaca-urologic-concerns-681?t=0)
- Preoperative urodynamics are very helpful in reoperative cloaca cases to understand bladder function before surgery. (opinion) [Ep 1 · 0:00](https://qa.library.globalcastmd.com/watch/cloaca-urologic-concerns-681?t=0)
- Intermittent catheterization is extremely stressful and difficult for families; experienced nurses and peer family support are important resources. (clinical) [Ep 1 · 17:14](https://qa.library.globalcastmd.com/watch/cloaca-urologic-concerns-681?t=1034)
- Girls are often able to catheterize themselves per urethra with supervision by age 6-7 years. (clinical) [Ep 1 · 21:54](https://qa.library.globalcastmd.com/watch/cloaca-urologic-concerns-681?t=1314)
- Mitrofanoff placement in cloaca patients is no different technically than in other patient populations such as spina bifida, posterior urethral valves, or bladder exstrophy. (clinical) [Ep 1 · 21:54](https://qa.library.globalcastmd.com/watch/cloaca-urologic-concerns-681?t=1314)
- Neurogenic bladder in pediatric populations is most commonly associated with spina bifida (myelomeningocele, lipomyelomeningocele, meningocele), but also occurs with spinal cord injury, cloacal exstrophy, anorectal malformations, and VACTERL association. — Lynn Wu (clinical) [Ep 2 · 1:06](https://qa.library.globalcastmd.com/watch/neurogenic-bladder-2897?t=66)
- Baseline evaluation of a newborn with myelomeningocele includes renal-bladder ultrasound and VCUG to assess for two kidneys, hydronephrosis, bladder shape, trabeculations, reflux, and bladder neck/urethral contour. — Lynn Wu (clinical) [Ep 2 · 2:34](https://qa.library.globalcastmd.com/watch/neurogenic-bladder-2897?t=154)
- The majority of children with spina bifida will have normal imaging studies at birth, making baseline documentation important. — Lynn Wu (clinical) [Ep 2 · 4:50](https://qa.library.globalcastmd.com/watch/neurogenic-bladder-2897?t=290)
- Urodynamics should be performed within the first month or couple of months of life to measure bladder pressure and compliance; a normal bladder maintains low pressure as it fills. — Lynn Wu (clinical) [Ep 2 · 5:10](https://qa.library.globalcastmd.com/watch/neurogenic-bladder-2897?t=310)
- A hostile bladder is defined by high pressure, instability (contracting during filling), or poor compliance; high bladder pressure is the most dangerous feature for renal function. — Lynn Wu (clinical) [Ep 2 · 6:20](https://qa.library.globalcastmd.com/watch/neurogenic-bladder-2897?t=380)
- Detrusor-sphincter dyssynergia (DSD) is a discoordination between bladder contraction and sphincter relaxation, resulting in high-pressure voiding; it can occur in any neurogenic bladder, including after spinal cord trauma. — Lynn Wu (clinical) [Ep 2 · 7:30](https://qa.library.globalcastmd.com/watch/neurogenic-bladder-2897?t=450)
- Clean intermittent catheterization (CIC) is the mainstay of neurogenic bladder management; it empties the bladder completely, reduces pressure, and bypasses sphincter dysfunction. — Lynn Wu (clinical) [Ep 2 · 9:50](https://qa.library.globalcastmd.com/watch/neurogenic-bladder-2897?t=590)
- Some urologists advocate universal early CIC from birth in all spina bifida patients to familiarize families, promote child acceptance, and potentially influence favorable bladder development. — Lynn Wu (opinion) [Ep 2 · 10:50](https://qa.library.globalcastmd.com/watch/neurogenic-bladder-2897?t=650)
- The traditional approach initiates CIC only in patients with worrisome urodynamic features or hostile bladders, to avoid unnecessary intervention and potential infection risk. — Lynn Wu (opinion) [Ep 2 · 12:10](https://qa.library.globalcastmd.com/watch/neurogenic-bladder-2897?t=730)
- Absolute indications for CIC include bladder pressure >40 cm H₂O, hydronephrosis, reflux, small bladder capacity, or detrusor-sphincter dyssynergia on urodynamics. — Lynn Wu (clinical) [Ep 2 · 14:31](https://qa.library.globalcastmd.com/watch/neurogenic-bladder-2897?t=871)
- Renal ultrasound should be repeated every 3–6 months in the first several years of life to monitor for hydronephrosis as the child and kidneys grow rapidly. — Lynn Wu (clinical) [Ep 2 · 20:38](https://qa.library.globalcastmd.com/watch/neurogenic-bladder-2897?t=1238)
- Urodynamics are generally repeated every 6–12 months; intervals are shortened if the bladder is hostile or parental compliance is uncertain. — Lynn Wu (clinical) [Ep 2 · 23:28](https://qa.library.globalcastmd.com/watch/neurogenic-bladder-2897?t=1408)
- Oxybutynin (Ditropan), an anticholinergic medication, relaxes the bladder and increases compliance; it is used in combination with CIC to manage hostile bladders. — Lynn Wu (clinical) [Ep 2 · 22:33](https://qa.library.globalcastmd.com/watch/neurogenic-bladder-2897?t=1353)
- Secondary reflux in neurogenic bladder occurs when high bladder pressure overwhelms the ureterovesical valve mechanism, forcing urine back into the kidneys. — Lynn Wu (clinical) [Ep 2 · 27:46](https://qa.library.globalcastmd.com/watch/neurogenic-bladder-2897?t=1666)
- High-grade reflux combined with recurrent UTIs is a dangerous situation: high pressure damages the kidneys and bacteria ascend via reflux, causing pyelonephritis and scarring. — Lynn Wu (clinical) [Ep 2 · 28:40](https://qa.library.globalcastmd.com/watch/neurogenic-bladder-2897?t=1720)
- Cutaneous vesicostomy—opening the bladder dome to the skin as an incontinent stoma—decompresses the bladder, eliminates high pressure, and resolves reflux; it is the easiest and quickest intervention in infants with hostile bladders. — Lynn Wu (clinical) [Ep 2 · 29:40](https://qa.library.globalcastmd.com/watch/neurogenic-bladder-2897?t=1780)
- Vesicostomy is generally a temporary measure; diapering becomes messier as the child grows, and closure requires a plan for ongoing bladder management. — Lynn Wu (clinical) [Ep 2 · 31:52](https://qa.library.globalcastmd.com/watch/neurogenic-bladder-2897?t=1912)
- Urinary continence in neurogenic bladder patients comes at a price: surgical interventions to achieve continence can adversely affect bladder function and create a hostile bladder where none existed before. — Lynn Wu (clinical) [Ep 2 · 33:28](https://qa.library.globalcastmd.com/watch/neurogenic-bladder-2897?t=2008)
- Incontinence in neurogenic bladder is multifactorial: bladder overactivity, sphincter dysfunction (always open or never open), insufficient bladder capacity, or a combination. — Lynn Wu (clinical) [Ep 2 · 34:30](https://qa.library.globalcastmd.com/watch/neurogenic-bladder-2897?t=2070)
- Bladder augmentation cystoplasty uses a segment of detubularized ileum or colon (typically 20–30 cm) anastomosed to the opened bladder to increase capacity and reduce pressure. — Lynn Wu (clinical) [Ep 2 · 40:00](https://qa.library.globalcastmd.com/watch/neurogenic-bladder-2897?t=2400)
- Bladder neck procedures to increase outlet resistance include rectus fascial sling, artificial urinary sphincter, urethral lengthening, or complete bladder neck closure. — Lynn Wu (clinical) [Ep 2 · 41:00](https://qa.library.globalcastmd.com/watch/neurogenic-bladder-2897?t=2460)
- A continent catheterizable channel (Mitrofanoff appendicovesicostomy or Yang-Monty ileal tube) provides a reliable route for bladder emptying when the native urethra is not suitable after reconstruction. — Lynn Wu (clinical) [Ep 2 · 42:00](https://qa.library.globalcastmd.com/watch/neurogenic-bladder-2897?t=2520)
- Surgical reconstruction must be individualized based on the patient's mobility, hand function, cognitive status, family support, and potential for independence. — Lynn Wu (clinical) [Ep 2 · 43:20](https://qa.library.globalcastmd.com/watch/neurogenic-bladder-2897?t=2600)
- Ethical considerations arise when parents are aging and the patient may require nursing home care; the feasibility of lifelong catheterization by caregivers must inform surgical decision-making. — Lynn Wu (opinion) [Ep 2 · 44:10](https://qa.library.globalcastmd.com/watch/neurogenic-bladder-2897?t=2650)
- Cystoscopic Botox injection into the detrusor muscle paralyzes the bladder, reducing overactivity and pressure; it is minimally invasive but not permanent and requires repeat injections. — Lynn Wu (clinical) [Ep 2 · 46:01](https://qa.library.globalcastmd.com/watch/neurogenic-bladder-2897?t=2761)
- Botox may delay or obviate the need for major reconstruction and help manage bladder dynamics safely, but may not fully resolve incontinence. — Lynn Wu (clinical) [Ep 2 · 47:00](https://qa.library.globalcastmd.com/watch/neurogenic-bladder-2897?t=2820)
- Transition to adult urology care is poorly developed at many hospitals; barriers include patient loss to follow-up, mistrust of new providers, and adult urologists' discomfort with complex congenital reconstructive history. — Lynn Wu (opinion) [Ep 2 · 48:24](https://qa.library.globalcastmd.com/watch/neurogenic-bladder-2897?t=2904)
- Structured transitional clinics starting in adolescence, with gradual handoff to adult providers and emphasis on patient independence, are needed but remain an unmet need. — Lynn Wu (opinion) [Ep 2 · 49:40](https://qa.library.globalcastmd.com/watch/neurogenic-bladder-2897?t=2980)

## Host summaries
Recaps by a host of what the experts said — not the host's own clinical position.
- In Dr. Pena's series of 193 cloaca patients old enough to assess continence with common channel <3 cm, almost one-third were on intermittent catheterization for infections, radiographic findings, or incontinence. — The host summarizing the discussion [Ep 1 · 0:00](https://qa.library.globalcastmd.com/watch/cloaca-urologic-concerns-681?t=0)
- In cloaca patients with common channel >3 cm, the rate of intermittent catheterization was much higher than in those with <3 cm channels. — The host summarizing the discussion [Ep 1 · 0:00](https://qa.library.globalcastmd.com/watch/cloaca-urologic-concerns-681?t=0)
- In a study of anorectal malformations, up to 40% of patients with abnormal spinal cord had urodynamic evidence of bladder abnormalities, higher than those with normal spinal cord. — The host summarizing the discussion [Ep 1 · 0:00](https://qa.library.globalcastmd.com/watch/cloaca-urologic-concerns-681?t=0)
- In children with solitary kidneys and CAKUT (congenital anomalies of kidney and urinary tract), 50% had chronic kidney disease and were on antihypertensive medication by age 9, compared to 33% in those without CAKUT. — The host summarizing the discussion [Ep 1 · 0:00](https://qa.library.globalcastmd.com/watch/cloaca-urologic-concerns-681?t=0)
- Long-term renal outcomes in cloaca patients show 44-75% develop chronic kidney disease across multiple centers (Great Ormond Street, Riley Hospital, Sick Kids). — The host summarizing the discussion [Ep 1 · 0:00](https://qa.library.globalcastmd.com/watch/cloaca-urologic-concerns-681?t=0)
- End-stage renal disease occurs in 10-15% of cloaca patients, much higher than the general population. — The host summarizing the discussion [Ep 1 · 0:00](https://qa.library.globalcastmd.com/watch/cloaca-urologic-concerns-681?t=0)
- Patients born with single kidney and hydronephrosis are very high risk and most likely will end up with kidney transplant. — The host summarizing the discussion [Ep 1 · 20:23](https://qa.library.globalcastmd.com/watch/cloaca-urologic-concerns-681?t=1223)
- Prior to the widespread use of clean intermittent catheterization in the 1970s, renal deterioration was the most common cause of mortality in patients with spina bifida. — Ray summarizes what Dr. Al Ray said [Ep 2 · 9:37](https://qa.library.globalcastmd.com/watch/neurogenic-bladder-2897?t=577)
- Some advocate prophylactic oxybutynin in all spina bifida patients from birth, though evidence is insufficient and the medication has side effects. — Ray summarizes what Dr. Al Ray said [Ep 2 · 22:33](https://qa.library.globalcastmd.com/watch/neurogenic-bladder-2897?t=1353)

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