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Follow-up of long-term treatment with clean intermittent catheterization for neurogenic bladder in children
Wachira Kochakarn1, Krisada Ratana-Olarn, Panuwat Lertsithichai
1Division of Urology, Department of Surgery, Faculty of Medicine, Ramathibodi Hospital and Medical School, Mahidol University, Bangkok 10400, Thailand. ravkc@mahidol.ac.th
Insights
Early clean intermittent catheterization (CIC) for pediatric neurogenic bladder in myelomeningocele patients leads to better long-term renal and bladder outcomes. Prompt treatment, especially within the first year of life, is recommended for improved results.
Area of Science:
- Pediatric Urology
- Nephrology
- Spina Bifida Research
Background:
- Myelomeningocele frequently causes neurogenic bladder, leading to potential renal damage.
- Long-term management of neurogenic bladder in children is crucial for preventing complications.
Purpose of the Study:
- To evaluate the long-term efficacy of clean intermittent catheterization (CIC) for neurogenic bladder in children with myelomeningocele.
- To compare outcomes between early (<1 year) and late (>3 years) initiation of CIC treatment.
Main Methods:
- Retrospective review of 67 pediatric myelomeningocele patients with neurogenic bladder.
- Patients divided into early (Group 1) and late (Group 2) treatment groups, followed for over 11 years.
- Outcomes assessed included renal function (BUN, creatinine), hydronephrosis, UTIs, and need for augmentation cystoplasty.
Main Results:
- Early CIC (Group 1) showed significantly lower rates of elevated BUN/creatinine, hydronephrosis, and need for augmentation cystoplasty compared to late CIC (Group 2).
- Group 2 experienced earlier renal deterioration and more severe hydronephrosis.
- No significant difference in upper urinary tract infection rates was observed between groups.
Conclusions:
- Early initiation of CIC for neurogenic bladder in pediatric myelomeningocele patients yields superior long-term renal and bladder outcomes.
- Treatment is recommended as early as possible, ideally within the first year of life, to optimize results.
Objectives:
To assess the results of long-term clean intermittent catheterization (CIC) treatment for neurogenic bladder in children born with myelomeningocele, and to compare the long-term results between the early treatment group (< 1 year old) and late treatment group (> 3 years old).
Methods:
Thirty-six paediatric patients with myelomeningocele who were treated in the first year of life (Group 1) and 31 cases who were treated after the age of 3 years (Group 2) were followed regularly for at least 11 years. All medical records were reviewed and long-term results of treatment, including increases in blood urea nitrogen (BUN) and serum creatinine, development of hydronephrosis, recurrent upper urinary tract infection, and the number of augmentation cystoplasties needed, were noted. Kaplan-Meier methods were used to analyse time-to-event data.
Results:
Mean age at start of treatment was 6.88 months (range, 3-1 months) in Group 1 and 44.97 months (range, 37-60 months) in Group 2. Increases in BUN and serum creatinine were found in 12 cases (33.3%) in Group 1 and 19 cases (61.3%) in Group 2. Patients in Group 2 showed earlier renal deterioration and worse renal function at the last follow-up. Hydronephrosis was found in 10 cases (27.8%) in Group 1 and 18 cases (58.1%) in Group 2. Patients in Group 2 also had earlier and more severe hydronephrosis. Augmentation cystoplasty was needed in five cases (13.9%) in Group 1 and 10 cases (32.3%) in Group 2. The results of surgery were better in Group 1 than in Group 2, and surgery was needed earlier in Group 2 compared with Group 1. There was no significant difference regarding upper urinary tract infection between the two groups.
Conclusions:
For most patients and with close long-term follow-up, early treatment of neurogenic bladder using CIC in children born with myelomeningocele yields better results than late treatment. In our experience, treatment is recommended as soon as possible, especially during the first year of life.
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