Tower Bladder: A Silent Threat in Pediatric Neurogenic Bladder – An Evaluation of Clinical Outcomes Based on Radiological and Urodynamic Markers

Objective: This study aimed to assess the prognostic significance of “tower bladder” morphology in pediatric patients with neurogenic bladder, focusing on its association with radiological and urodynamic indicators and its predictive value for renal impairment. Materials and Methods: We retrospectively reviewed 164 children (mean age: 7.7 ± 4.6 years) with neurogenic bladder managed at Gaziantep City Hospital between October 2023 and May 2024. Evaluations included voiding cystourethrography (VCUG) for bladder morphology and bladder diameter ratio (BDR), vesicoureteral reflux (VUR) grading, and dimercaptosuccinic acid (DMSA) scintigraphy for renal scarring. Urodynamic parameters, age-adjusted serum creatinine, timing of clean intermittent catheterization (CIC), and anticholinergic therapy duration were recorded. Results: Tower bladder morphology was observed in 71.3% of patients and was significantly associated with higher intravesical pressure (46.2 ± 24.2 vs. 26.7 ± 19.1 cmH₂O; p < 0.001), elevated BDR (p < 0.001), high-grade VUR (p = 0.006), and increased renal scarring (p = 0.020). Late CIC initiation was linked to tower bladder (p = 0.019). Although anticholinergic therapy reduced pressure (p < 0.001), it had limited effect on renal preservation. Conclusion: Tower bladder is a morphological marker of poor prognosis in pediatric neurogenic bladder, correlating with high intravesical pressure and renal risk. Early CIC and pharmacotherapy are essential to prevent irreversible damage. Integration of radiologic and functional data is critical for individualized risk assessment and management planning.