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Urinary catheters in spina bifida
Insights
Catheterization for neuropathic bladder in children yielded good results in 70% of girls and 50% of boys. Vesico-ureteric reflux is a relative contraindication, especially without severe disabilities.
Area of Science:
- Pediatric Urology
- Nephrology
- Neurology
Background:
- Neuropathic bladder affects children, leading to incontinence and potential kidney damage.
- Catheterization is a management option for these complex cases.
Purpose of the Study:
- To evaluate the efficacy and safety of intermittent or indwelling catheterization in children with neuropathic bladder.
- To identify factors influencing outcomes and contraindications for catheterization.
Main Methods:
- Retrospective analysis of 56 children with neuropathic bladder managed with catheterization since 1974.
- Indications included incontinence, hydronephrosis, and difficulty with bladder expression.
Main Results:
- Successful catheterization in 70% of girls and 50% of boys.
- Catheter abandonment in 7 children due to parental non-compliance.
- Upper tract deterioration occurred in 33% of children with pre-existing hydronephrosis and vesico-ureteric reflux.
Conclusions:
- Catheterization is effective for neuropathic bladder in children, though outcomes vary by sex.
- Vesico-ureteric reflux is a relative contraindication, particularly when upper tract deterioration is a risk.
- Perineal urethrostomy may be a viable alternative for specific patient groups.
Abstract:
Since 1974, 56 children with a neuropathic bladder were selected for intermittent or indwelling catheterisation. Indications for catheterisation included incontinence, hydronephrosis, and/or difficulty with bladder expression. Good results were obtained in 70% of girls and 50% of boys. The catheter was abandoned in 7 children, mainly because of lack of cooperation from the parents. Deterioration occurred only in those children with both hydronephrosis and vesico-ureteric reflux prior to catheterisation. Of the latter group of children, 33% suffered upper tract deterioration, and we now consider vesico-ureteric reflux to be a relative contra-indication to catheterisation, except in those children with severe disabilities and deformities, in whom antireflux surgery or urinary diversion would be unacceptable or technically difficult. Indwelling penile catheters should not be recommended for boys, but catheterisation via a perineal urethrostomy may prove helpful in those unable either to catheterise themselves intermittently or to wear a penile appliance.