To explore the surgical selection and therapeutic evaluation of neurogenic bladder in children.

A total of 32 cases were selected in this study, which is the patients in our hospital since January 2014. Their age is 6 months to 8 years old, and the ratio of men and women to 2:1. Among the total cases, 25 cases had lumbosacral masses, tethered cord syndrome (TCS) who underwent surgical lysis; 6 cases of non surgical lysis; 1 case had space occupying lesion in spinal canal (Such as tumor, dermoid cyst and so on.) and underwent surgical treatment. The clinical manifestations were incontinence of urine and feces, and 17 cases amalgamate obvious lower extremities abnormalities, such as muscle atrophy, muscle strength reduction, high arch foot and lower limb limp, 11 cases of unilateral lower extremities were involved, and 5 cases were bilateral. MRU, IVP, VCUG and urological ultrasonic examination were routinely used in all cases before and after operation. Examination revealed small bladder, Christmas tree change, accompanied by multiple diverticulum, 5 cases were simple vesicoureteral reflux, and 6 cases were bilateral vesicoureteral reflux. The PAC angle and the obliquity of the bladder and the posterior angle of the vesicourethral were measured before and after operation. And besides urodynamic examination and anorectal manometry before and after operation were also underway. Operative methods: ①suspension of pelvic floor, ②bladder neck suspension, ③bladder augmentation, ④Malone procedure, and ⑤anti-vesicoureteral reflux. ICI-Q-SF score, Li Zheng fecal incontinence clinical score, urodynamic examination and anorectal manometry were used for comprehensive evaluation before and after operation. The evaluating indicator of urodynamic examination: the ratio of the actual volume of the bladder to the estimated capacity, the ratio of residual urine volume to actual bladder capacity, bladder compliance, bladder pressure at the final phase of filling, urethral functional length. Rehabilitation training for half a month after operation, such as intermittently open urethral catheterization and then intermittent catheterization, biofeedback and so on. Postoperative follow-up and urodynamic evaluation were performed.

The bladder capacity generally increased 150~200ml after operation. Postoperative follow-up of 8 months to 3 years with functional training and intermittent catheterization, after Malone operation with anterograde enema. The children are stability of the disease and able to integrate into the society. They are not wet pants and benches during school. A total of 32 cases in the study, 16 cases of surgical combination with operative methods ①, ② and ③; 5 cases of surgical combination with operative methods ①, ②, ③ and ④; 6 cases of surgical combination with operative methods ①, ②, ③ and ⑤; 2 cases of surgical combination with operative methods ①, ② and ⑤; 1 case of surgical combination with operative methods ① and ②; 1 case of surgical combination with operative methods ② and ⑤; 1 case of surgical combination with operative methods ③ and ⑤. There were 104 times of all operative procedures in 32 children, and average 3.25 cases needed of surgical methods for each child（104/32）.

The treatment of neurogenic bladder should adhere to the principle of comprehensive treatment, a single treatment is often difficult to get the goal of treatment, and a variety of operative combinations are needed to achieve the therapeutic effect always. Pelvic floor muscle strengthening, bladder neck suspension and bladder enlargement surgery are the basic surgical treatments for neurogenic bladder. At the same time, postoperative rehabilitation training is also indispensable for ensuring the efficacy of surgery.

The surgical treatment of neurogenic bladder in children is complicated and varied. Each surgical method has its limitations. Several surgical methods must be used in conjunction with the patient's specific conditions to achieve therapeutic effects.