Related Experiment Video
Updated: Jul 26, 2025
Detrusor Underactivity Model in Rats by Conus Medullaris Transection
Published on: August 28, 2020
Early Onset Clean Intermittent Catheterization May Decrease Prevalence and Severity of Urinary Concentration Defects
Mohsen Ebrahimnejad1, Seyyed Mohammad Ghahestani2
1Fellow of pediatric urology, Department of pediatric urology, Tehran University of Medical Sciences, Children Medical Center Hospital, Tehran, Iran. mrhamed2009@gmail.com.
Insights
Early clean intermittent catheterization (CIC) in children with myelomeningocele helps preserve kidney function by reducing urinary concentration defects. This management strategy is more effective than late-onset CIC for neurogenic bladder patients.
Area of Science:
- Urology
- Pediatric Nephrology
- Developmental Pediatrics
Background:
- Myelomeningocele, the most severe form of spina bifida, presents lifelong urologic challenges.
- Urinary concentration defects are common but understudied consequences in myelomeningocele.
- Effective management of neurogenic bladder is crucial for long-term patient health and public health resources.
Purpose of the Study:
- To retrospectively evaluate the impact of early-onset clean intermittent catheterization (CIC) on urinary concentration defects in myelomeningocele patients.
- To compare the severity of urinary concentration defects between early (<2 years) and late (≥2 years) CIC starters.
- To assess the long-term effects of CIC timing on kidney function preservation.
Main Methods:
- A 10-year retrospective cohort study involving 130 myelomeningocele patients with neurogenic bladder.
- Convenience sampling method used for patient selection.
- Comparison of polyuria index ratio (PIR) and nocturnal polyuria index (NPI) between early and late CIC onset groups.
Main Results:
- Patients receiving early-onset CIC (<2 years) exhibited significantly lower PIR and NPI values compared to late-onset CIC (≥2 years) patients.
- Lower PIR and NPI indicate better urinary concentration ability and reduced risk of kidney damage.
- No adverse events were reported during the follow-up period, suggesting the safety of early CIC.
Conclusions:
- Early-onset CIC is more effective than late-onset CIC in preserving kidney urinary concentration abilities in myelomeningocele patients.
- Initiating CIC before the age of two years is a beneficial strategy for managing neurogenic bladder.
- This finding supports the early implementation of CIC to mitigate urologic complications in pediatric spina bifida.
Purpose:
Myelomeningocele is the most severe form of spina bifida. Management of urologic consequences of spina bifida is life long, demanding and costly for both the patient and the public health system. There is a paucity of data in the literature regarding concentration defects and their consequences on this disease. This paper aims to describe retrospectively the effect of early onset clean intermittent catheterization (CIC) in on the severity of urinary concentration defects in myelomeningocele patients with neurogenic bladder in a retrospective observational study.
Materials And Methods:
In this 10-year retrospective cohort study, children with myelomeningocele were selected with the Convenience sampling method. Demographic characteristics, polyuria index ratio (PIR) defined as 24 hour urine output of each patient divided by the maximum normal urine output of the same patient in a healthy state, and nocturnal polyuria index (NPI) were compared between early starters (< 2 years old) or late starters (≥ 2 years old) groups.
Results:
Seven patients who underwent cystoplasty were excluded and 130 patients (63.8% male, 5.4 ± 3.2 years old, 14.3 ± 2.83 Kg, 28.5% early onset CIC) were investigated. PIR > 1 in inset (1.7 ± 0.2 vs. 2.2 ± 0.5, P = 0.021) and outset (1.5 ± 0.32 vs. 2.5 ± 0.7, P = 0.004) were lower in early starters group than in late starters group. NPI in inset (0.2 ± 0.007 vs. 0.32 ± 0.10, P = 0.018) and outset (0.25 ± 0.15 vs. 0.42 ± 0.095, P = 0.007) were also lower in the early starters group. No further adverse events were reported during the follow-up period.
Conclusion:
Early onset CIC is more effective than late-onset CIC in preserving the urinary ability of kidneys in myelomeningocele patients.
Related Concept Videos
01:20Physiology of the Genitourinary System III: Urine Concentration and Dilution
01:26The Micturition Reflex
The process begins with bladder filling, where the bladder wall stretches as urine accumulates. This stretching activates the urine storage reflex, mediated by the sacral spinal segments and the pontine storage center. Efferent sympathetic impulses stimulate the detrusor muscle to relax and the internal urethral sphincter to contract, facilitating...
01:21Nursing Assessment of the Genitourinary System I: Health History
01:22Imaging Studies VI: Voiding Cystourethrography and Cystography
01:17Urinary Tract Infection IV: Nursing Management
01:20Disorders of the Urinary System
Urinary tract infections (UTIs) are one of the most common urinary system disorders. They are caused by bacteria that enter the urethra and can spread to the bladder resulting in cystitis. Pyelonephritis is the result of a UTI that has ascended to the level of the...