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Results of clean intermittent catheterization for children with neurogenic bladders
Insights
Clean intermittent catheterization programs are feasible in rural settings. This study found that a genitourinary irrigant can decrease bacteriuria in children undergoing catheterization.
Area of Science:
- Pediatrics
- Urology
- Infectious Disease Management
Background:
- Clean intermittent catheterization (CIC) is a management strategy for pediatric lower urinary tract dysfunction.
- Long-term outcomes and feasibility of CIC programs in rural settings require further investigation.
Purpose of the Study:
- To evaluate the feasibility and outcomes of a CIC program in a rural pediatric population.
- To assess the impact of a silver nitrate genitourinary irrigant on bacteriuria and infection rates.
Main Methods:
- A cohort of 49 pediatric patients managed with CIC for 1-4 years was reviewed.
- Patients received CIC with a 1:1000 silver nitrate solution instilled post-catheterization.
- Management involved nurse practitioners, community, and school personnel.
Main Results:
- 88% of patients were essentially bacteriuria-free; 65% were infection-free.
- 49% achieved total continence, with 25% experiencing mild incontinence.
- Renal function improved in 8/11 patients with initial low clearances; 1/9 with pre-existing reflux improved.
- New reflux developed in 8 patients during therapy, with 4 requiring ureteral reimplantation.
Conclusions:
- A clean intermittent catheterization program is a feasible and effective management strategy in a rural pediatric setting.
- The use of a genitourinary irrigant (silver nitrate) was associated with a decrease in bacteriuria.
- While generally successful, careful monitoring for potential complications like reflux is essential.
Abstract:
Forty-nine patients were placed on a regimen of clean intermittent catheterization one to four years prior to this review. The children were intermittently catheterized, and a silver nitrate solution 1:1000 was instilled after each catheterization. Nurse practitioners, and community and school personnel contributed to the management. Twenty-one patients were continent with anticholinergics, and 18 also required alpha-adrenergic agents. Eighty-eight per cent were essentially bacteriuria-free, 65 per cent were essentially infection-free, and forty-nine per cent were totally continent. The remaining 25 had mild incontinence. Eleven had clearances below 85 mm/min with 8 reverting to normal on therapy. Nine had reflux prior to the study and one improved. In 8 patients reflux developed during therapy; 4 had severe reflux which required ureteral reimplantation. The results demonstrated that a clean intermittent catheterization program is feasible in a rural setting and that a genitourinary irrigant does decrease bacteriuria.