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Epididymitis in children and adolescents on clean intermittent catheterisation
V S Thirumavalavan1, P G Ransley
1Hospital for Sick Children, London, UK.
Insights
Clean intermittent catheterisation (CIC) in children and adolescents can lead to epididymo-orchitis, particularly in those with neuropathic bladders and frequent urinary tract infections. Long-term antibiotics may help prevent recurrent attacks.
Area of Science:
- Pediatric Urology
- Infectious Diseases
- Nephrology
Background:
- Clean intermittent catheterisation (CIC) is a common procedure for managing bladder dysfunction in children and adolescents.
- Epididymo-orchitis is a potential complication, but its incidence and risk factors in this population require further investigation.
Purpose of the Study:
- To determine the incidence of epididymo-orchitis in pediatric patients undergoing CIC.
- To identify predisposing factors associated with the development of epididymo-orchitis in this cohort.
Main Methods:
- Retrospective review of medical records for 119 children and adolescents on CIC.
- Analysis of patient data including duration of CIC, bladder type, urinary tract infection (UTI) frequency, and antibiotic use.
- Calculation of epididymo-orchitis incidence and identification of associated risk factors.
Main Results:
- Epididymo-orchitis occurred in 10 out of 99 evaluable patients (1 episode per 10 patient years).
- Higher incidence was observed in patients with neuropathic bladders and more than 2 symptomatic UTIs annually.
- Prophylactic antibiotics did not decrease the incidence; however, long-term specific antibiotic therapy showed potential in preventing recurrent attacks.
Conclusions:
- CIC is associated with a notable incidence of epididymo-orchitis in children and adolescents.
- Neuropathic bladder and recurrent UTIs are significant risk factors for developing epididymo-orchitis.
- While prophylactic antibiotics are ineffective, targeted long-term antibiotic treatment may be beneficial for preventing recurrent episodes.
Abstract:
The records of 119 children and adolescents on clean intermittent catheterisation (CIC) were reviewed to assess the incidence and predisposing factors, if any, of epididymo-orchitis. CIC had been performed for a total of 448 patient years with a mean of 4.5 years (range 3 months to 19 years). Of the evaluable 99 patients, 10 suffered attacks of epididymo-orchitis after commencing CIC. There was an equal incidence on both sides. Three patients had recurrent attacks. Epididymitis occurred at the rate of 1 episode for 10 patient years. Those who had neuropathic bladders and more than 2 symptomatic urinary tract infections annually had a higher incidence. Prophylactic antibiotics did not reduce the incidence but long-term specific antibiotic therapy may prevent further attacks. Vasectomy and orchidectomy had to be done in 2 patients for recurrent attacks and intractable sepsis.