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Institutional Outcomes of Immediate vs Delayed or No Clean Intermittent Catheterization in Infant Neurogenic Bladder
Michael E Chua1,2,3, Kai Iwano1, Joana Dos Santos1
1Division of Urology, The Hospital for Sick Children, Toronto, Ontario, Canada.
Neurourology and Urodynamics
|August 7, 2026
Summary
Starting clean intermittent catheterization (CIC) immediately in infants with neurogenic lower urinary tract dysfunction (NLUTD) increased bacteriuria but not symptomatic urinary tract infections (UTIs). Delayed CIC was linked to worse outcomes, suggesting risk-adapted initiation is beneficial.
Area of Science:
- Pediatric Urology
- Neurogenic Bladder Management
- Infectious Disease Epidemiology
Background:
- The optimal timing for clean intermittent catheterization (CIC) in infants with neurogenic lower urinary tract dysfunction (NLUTD) is not well-established.
- This study investigates the impact of early versus delayed CIC initiation on infectious and renal/bladder ultrasound (RBUS) outcomes in infants with NLUTD.
Purpose of the Study:
- To compare 12-month infectious and RBUS outcomes in infants with NLUTD initiated on CIC within 30 days of life versus those managed without neonatal CIC.
- To analyze outcomes across three groups: immediate CIC (≤30 days), never CIC, and delayed CIC (>30 days).
Main Methods:
- A single-center ambispective cohort study included 221 infants diagnosed with NLUTD.
- Primary comparison: immediate CIC (n=53) vs. non-immediate management (n=168).
- Secondary analysis stratified non-immediate management into never CIC (n=116) and delayed CIC (n=52), assessing outcomes through 12 months.
Main Results:
- Immediate CIC was associated with higher bacteriuria rates (43% vs. 24%), likely due to catheter colonization.
- Symptomatic urinary tract infection (UTI) incidence was similar between immediate and non-immediate CIC groups (47% vs. 38%).
- Delayed CIC initiation showed the highest symptomatic UTI rate (73%) and more febrile UTIs, with increased RBUS abnormalities.
Conclusions:
- Immediate CIC in NLUTD infants is linked to increased bacteriuria but not higher symptomatic UTI rates.
- Delayed CIC initiation appears associated with worse infectious and imaging outcomes, potentially reflecting reactive management rather than a causal effect of delay.
- Findings support a risk-adapted approach to CIC initiation and symptom-based UTI diagnosis to optimize antimicrobial stewardship.
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