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Five-year experience with clean intermittent catheterization in children
Insights
Clean intermittent catheterization (CIC) is a safe and effective treatment for children with neurogenic bladder dysfunction. This study found a low complication rate and stable upper tracts in most patients, recommending early initiation of CIC.
Area of Science:
- Pediatric Urology
- Nephrology
- Neurology
Background:
- Neurogenic vesical dysfunction affects children's bladder emptying.
- Clean intermittent catheterization (CIC) is a management option.
- Long-term outcomes of CIC in pediatric populations require evaluation.
Purpose of the Study:
- To assess the efficacy and safety of CIC in children with neurogenic vesical dysfunction.
- To evaluate complications, urinary tract infections, and upper tract changes associated with CIC.
- To determine the optimal age for initiating CIC.
Main Methods:
- Retrospective analysis of 98 children treated with CIC over five years.
- Follow-up data available for 73 patients.
- Assessment of complication rates, sterile urine maintenance, reflux changes, and upper tract status.
Main Results:
- Low major complication rate (7%).
- 21% maintained sterile urine; no new pyelonephritis cases.
- 14% of refluxing renal units stopped refluxing; de novo reflux occurred in 2 units.
- 79% showed stable upper tracts; 14% had increased calicectasis.
- 31 patients were under three years old at CIC initiation.
Conclusions:
- CIC is recommended as a primary treatment for neurogenic vesical dysfunction in children.
- Early initiation of CIC is advised for optimal outcomes.
- While sterile urine is not always achieved, CIC effectively manages bladder emptying and stabilizes upper tracts.
Abstract:
Ninety-eight children have been treated with clean intermittent catheterization (CIC) over a five-year period. Follow-up in 73 of these is presented herin. The complication rate encountered with the technique is low (7 per cent major complications). Only 21 per cent of the patients were able to maintain persistently sterile urine, although no new bouts of pyelonephritis were encountered in the group since our report of three years ago. Six of 44 (14 per cent) refluxing renal units stopped refluxing on CIC, but in two units reflux de novo developed while on treatment. Most patients (79 per cent) demonstrated stable upper tracts on CIC, while 14 per cent showed increased calicectasis with 7 per cent showing improvement. Thirty-one of the patients were less than three years of age when begun on clean intermittent catheterization. We recommend CIC as the treatment of choice in neurogenic vesical dysfunction where total bladder emptying is a problem and advise that it be started as early as possible.