Early start of clean intermittent catheterization versus expectant management in children with spina bifida
Wael Elzeneini1, Ramy Waly1, David Marshall1
1Department of Paediatric Urology, Royal Belfast Hospital for Sick Children, Northern Ireland.
Insights
Early clean intermittent catheterization (CIC) significantly reduced renal scarring in infants with spina bifida (SB). This management strategy is recommended from birth to protect kidneys in all SB patients.
Area of Science:
- Pediatric Urology
- Nephrology
- Developmental Pediatrics
Background:
- Spina bifida (SB) is a complex congenital condition often leading to neurogenic bladder.
- Neurogenic bladder can cause urinary tract issues, including infections and kidney damage.
- Historically, expectant management was common for infants with SB.
Purpose of the Study:
- To evaluate the effectiveness of early clean intermittent catheterization (CIC) in reducing renal scarring in infants with spina bifida.
- To compare renal outcomes in infants with SB managed with early CIC versus historical expectant management.
Main Methods:
- Retrospective cohort comparison study.
- Analyzed data from infants with SB treated with early universal CIC (1997-2010) and compared to a historical cohort (1985-1994) managed expectantly.
- Renal scarring assessed using Dimercaptosuccinic acid (DMSA) scans.
Main Results:
- The recent cohort (early CIC) showed a significantly lower rate of renal scarring (18.8%) compared to the historical cohort (39%) (P=0.002).
- Delayed detection of renal scarring was observed in the early CIC group, with fewer cases identified by age 4 (47% vs 72%).
- Mean follow-up was 11.4 years for the early CIC group and 4-13 years for the historical group.
Conclusions:
- Early clean intermittent catheterization (CIC) demonstrates significant renal protective benefits in infants with spina bifida.
- The findings support the recommendation of initiating CIC from birth for all patients diagnosed with SB.
- This proactive management approach appears to reduce the incidence and delay the detection of renal scarring.
Purpose:
We instituted early clean intermittent catheterization (CIC) in 1997 for all newborn infants with spina bifida (SB). We compared this group to a historical group managed expectantly to see if early catheterization was associated with a reduction in renal scar rate as determined by DMSA scanning.
Methods:
Data were studied retrospectively on all infants with SB over a recent 13-year period who were treated with early universal CIC in a regional pediatric urology department. These were compared to our previously published outcomes in a historical group (1985-1994) that was managed expectantly [Brown et al. Chronic pyelonephritis in association with neuropathic bladder. Eur J Pediatr Surg 1999;9 Suppl 1:29-30.] RESULTS: 114 infants were born with SB from 1997 to 2010, of which 13 were excluded from this analysis. Mean follow-up was 11.4 years. In the historical cohort there were 126 infants born from 1985 to 1994, with 26 exclusions; follow-up then ranged from 4 to 13 years. DMSA scan showed renal scarring in 19/101 (18.8%) of the recent cohort versus 39/100 (39%) of the previous group (P = 0.002). Renal scarring at a later age also appeared to be a feature of the recent group, with first detection occuring by 4 years in only 9/19 (47%) in the latest cohort compared to 28/39 (72%) in the historical cohort.
Conclusion:
Based on these renal protective data, we recommend indwelling and then intermittent catheterization from birth in all patients with SB.
Level Of Evidence:
Level III.
Type Of Study:
Retrospective, cohort comparison study.
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