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[Effect of intermittent catheterization on urinary tract infections and incontinence in children with spina bifida]
J D van Gool1, T P de Jong, T M Boemers
1Pädiatrisches Nierenzentrum, Universitätsklinik für Kinder und Jugendliche Het Wilhelmina Kinderziekenhuis, Utrecht.
Insights
Clean intermittent catheterization (CIC) significantly reduced urinary tract infections (UTIs) and improved incontinence in children with myelomeningocele (MMC). This management strategy helps prevent kidney damage and bladder fibrosis.
Area of Science:
- Pediatric Urology
- Nephrology
- Neurology
Context:
- Myelomeningocele (MMC) often leads to bladder dysfunction, including detrusor-sphincter dyssynergia.
- This dysfunction can cause urinary tract infections (UTIs) and incontinence, potentially damaging the kidneys.
- Early intervention is crucial to prevent long-term complications.
Purpose:
- To evaluate the efficacy of clean intermittent catheterization (CIC) in managing bladder dysfunction in children with MMC.
- To assess the impact of CIC on the incidence of UTIs and the degree of incontinence.
- To determine if CIC can prevent secondary complications like kidney damage and bladder fibrosis.
Summary:
- A study assessed 61 children with MMC who initiated CIC between 1985-1988, with a mean follow-up of 45.3 months.
- Results showed a significant decrease in UTI incidence (p < 0.001) and a significant improvement in incontinence (p < 0.001) during CIC.
- The mean age at CIC initiation was 6.9 years.
Impact:
- CIC is an effective method for managing bladder dysfunction in children with MMC.
- It significantly reduces the risk of recurrent UTIs, thereby protecting kidney function.
- CIC helps prevent bladder wall fibrosis, preserving detrusor compliance and overall bladder health.
Abstract:
Although the primary objective of clean intermittent (self) catheterization (CIC) was to regain continence in (older) children with myelomeningocele (MMC), we used the method also in the very young with detrusor-sphincter dyssynergia, to prevent future damage from the combined effects of obstruction and urinary tract infection (UTI). The results, in terms of incidence of UTI and degree of incontinence before and during CIC, were assessed in 61 children with MMC who had started CIC between 1985 and 1988. Mean follow up was 45.3 +/- 27.3 months, mean age at the start of CIC was 6.9 +/- 4.6 years. The incidence of UTI during CIC proved significantly lower than before CIC (chi 2 = 20.92, p less than 0.001), and the improvement in incontinence was also statistically significant (chi 2 = 45.16, p less than 0.001). In children with MMC, CIC seems ideally suited to prevent damage to the kidneys from the life-long problem of recurrent UTI's. It will also help in preventing bladder wall fibrosis--an important cause of loss of detrusor compliance--secondary to repeated UTIs.