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Overnight catheter drainage in children with poorly compliant bladders improves post-obstructive diuresis and urinary
Michael T Nguyen1, Christina L Pavlock, Stephen A Zderic
1Division of Urology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104, USA.
Insights
Overnight catheter drainage (OCD) effectively manages poorly compliant bladders in children, reducing urinary incontinence, infections, and improving upper tract dilatation. This treatment offers an alternative to bladder augmentation for select pediatric patients.
Area of Science:
- Pediatric Urology
- Pediatric Nephrology
- Urodynamics
Background:
- Poorly compliant bladders in children can lead to significant complications.
- Previous treatments like intermittent catheterization and anticholinergics may fail.
Purpose of the Study:
- To evaluate the efficacy of overnight catheter drainage (OCD) in children with poorly compliant bladders.
- To assess outcomes including continence, urinary tract infections (UTIs), and upper tract changes.
Main Methods:
- OCD was initiated in 11 children (6 boys, 5 girls) aged 7.5 years after failure of other therapies.
- Etiologies included various congenital and neurological conditions.
- Parameters measured: post-obstructive diuresis, serum creatinine, upper tract dilatation, UTIs, and incontinence.
Main Results:
- Daytime urinary incontinence resolved in 6/9 patients and improved in 3/9.
- Recurrent febrile UTIs were eliminated in 3 children.
- Upper tract dilatation improved in 88% (7/8) of patients; serum creatinine remained unchanged.
Conclusions:
- OCD is effective in reducing diuresis, UTIs, and improving upper tract dilatation and continence in select children.
- OCD combined with daytime clean intermittent catheterization may be an alternative to bladder augmentation for children with poorly compliant bladders and early renal compromise.
Purpose:
Overnight catheter drainage (OCD) has been suggested as a treatment for boys with valve bladder syndrome as well as those with polyuric renal failure. We report our experience using overnight catheter drainage in children with poorly compliant bladders.
Materials And Methods:
Between 1999 and 2004 OCD was initiated in 6 boys and 5 girls (median age 7.5 years) with poorly compliant bladders in whom aggressive daytime intermittent catheterization and anticholinergic use had failed. Etiologies of bladder dysfunction included posterior urethral valves in 1 case, The Hinman-Allen syndrome in 4, myelomeningocele in 2, neuroblastoma in 1, prune-belly syndrome in 1, transverse myelitis in 1 and sacral agenesis in 1. The amount of post-obstructive diuresis was calculated during urodynamics as the volume drained minus volume instilled divided by weight per hour. Other parameters evaluated included serum creatinine, degree of upper tract dilatation, and episodes of urinary tract infection (UTI) and incontinence.
Results:
Median duration of OCD and followup was 28 months, respectively. One patient did not tolerate overnight drainage. Of 9 patients who were incontinent before OCD daytime urinary incontinence resolved in 6 and improved in 3. Recurrent febrile UTIs in 3 children were eliminated. Despite no change in serum creatinine with overnight drainage, 7 of 8 patients (88%) with upper tract dilatation improved on followup ultrasound.
Conclusions:
In select children with poorly compliant bladders OCD reduces diuresis, reduces the frequency of UTIs, improves upper tract dilatation and improves continence. Overnight drainage in conjunction with daytime clean intermittent catheterization may prove to be an alternative to bladder augmentation in select children with poorly compliant bladders and early stages of renal compromise.
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