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Management of neuropathic urinary incontinence in children by intermittent catheterisation
Insights
Intermittent catheterization effectively treats neuropathic bladder incontinence in children, with most achieving daytime control. Manometric studies aided treatment prediction and improved upper urinary tract conditions.
Area of Science:
- Pediatric Urology
- Nephrology
- Neurology
Background:
- Neuropathic bladder causes urinary incontinence in children.
- Intermittent catheterization is a management option.
Purpose of the Study:
- To evaluate the efficacy of intermittent catheterization in children with neuropathic bladder.
- To assess the role of manometric studies in predicting treatment outcomes.
- To monitor effects on upper urinary tract function and renal health.
Main Methods:
- Forty-nine children with neuropathic bladder underwent intermittent catheterization.
- Manometric studies (urethral closing pressures, intravesical pressure/volume) were performed.
- Cystography and intravenous urography were used for initial and follow-up assessments.
Main Results:
- 93% achieved daytime urinary continence with a 3-hourly regimen.
- 55% required anticholinergic medications (propantheline, imipramine) for daytime control.
- 87% showed improved night-time continence.
- Manometric studies reliably predicted the need for medication.
- Upper urinary tract dilatation resolved or improved in all affected children.
- Two children with early renal failure showed favorable responses.
Conclusions:
- Intermittent catheterization is an effective treatment for neuropathic bladder in children.
- Manometric studies are valuable for predicting treatment success and guiding therapy.
- This approach can improve upper urinary tract status and renal function in affected children.
Abstract:
Forty-nine children with urinary incontinence owing to neuropathic bladder were treated by intermittent catheterisation. Manometric studies to determine urethral closing pressures and intravesical pressure/volume relationships were performed before or during treatment in all children. Cystography and intravenous urography were carried out at the beginning of treatment and intravenous urography was repeated after treatment for at least 12 months. Routine long-term antibacterial therapy was not used. With a 3-hourly catheterisation regimen a total of 46 (93%) children achieved day-time control but 27 (55%) did so only with the help of propantheline or imipramine or both of these. Night-time control was also substantially improved in 43 (87%) children. The manometric studies enabled a reliable prediction to be made on whether drugs would be required to achieve success. One child with an undilated urinary tract before treatment developed unilateral dilatation owing to mechanical problems during treatment. Upper urinary tract dilatation which was present before treatment in 20 children (33 kidneys) disappeared or improved in all. Early renal failure in 2 children also responded favourably. The technique had to be abandoned in 2 children.