200 Section - Recovery of urinary function in a 13-year-old girl with spina bifida occulta after lower back trauma using clean intermittent catheterization, sacral neuromodulation, and pelvic floor training: A Case Report

Case Diagnosis: A 13-year-old girl with spina bifida occulta developed urinary frequency and incomplete voiding after minor lower back trauma. Ultrasound showed high post-void residual urine, urodynamics revealed detrusor underactivity, and she was treated conservatively with CIC, t-SNM, and PFMT.

Case Description: After minor lower back trauma, the patient developed frequent urination, low voided volumes, and incomplete emptying without infection or neurological deficits. Examination revealed mild bladder distension and a small lumbosacral dimple. Ultrasound showed high post-void residual urine, and MRI confirmed spina bifida occulta without tethered cord. Urodynamics indicated detrusor underactivity. She underwent clean intermittent catheterization (CIC), transcutaneous sacral neuromodulation (t-SNM) twice weekly, and pelvic floor muscle training (PFMT), with education on catheter hygiene and monitoring. Over several months, residual urine decreased, though CIC was still needed for three months, and urinary frequency normalized. No infections or neurological complications occurred, demonstrating successful non-surgical recovery.

Discussions: This case highlights that spina bifida occulta, though usually asymptomatic, can predispose children to neurogenic bladder after minor trauma. The posterior vertebral arch defect increases sacral nerve vulnerability, causing detrusor underactivity. Early diagnosis and conservative management are crucial. Clean intermittent catheterization (CIC) ensures complete bladder emptying and prevents infection. Transcutaneous sacral neuromodulation (t-SNM) enhances detrusor function, while pelvic floor muscle training (PFMT) improves sphincter control. Literature supports combining these therapies for pediatric neurogenic bladder. Early intervention prevents renal complications and may avoid surgery. Regular ultrasound and urodynamic monitoring ensures safe recovery and long-term urinary health in children with occult spinal anomalies.

Conclusions: Minor lumbosacral trauma in children with spina bifida occulta can trigger transient neurogenic bladder due to sacral nerve vulnerability. Early recognition and conservative management with CIC, t-SNM, and PFMT restored bladder function and spontaneous voiding without surgery, highlighting the importance of non-invasive, multidisciplinary rehabilitation and regular monitoring.