[Intermittent catheterization as the basis for treatment of neurogenic bladder during childhood]

Neurogenic bladder (NB) frequently causes incomplete bladder emptying, which can lead to deterioration of the upper urinary tract (UUT), vesico-renal reflux (VRR) and incontinence. The aim of this study is to determine the degree of acceptance, performance and results of treatment of NB in children by intermittent catheterization (IC).

Of 121 children (50 girls and 38 boys) with NB, 88 were managed by intermittent catheterization. The mean age at treatment was 5.2 years (range 20 days-13 years). PVC catheters were employed and reutilized for 3 or 4 weeks. Catheters were aseptic but not sterile. Antimicrobial prophylactic therapy was not administered except in patients with VRR. The statistical study was descriptive and results were compared using the Pearson chi square test.

90% had 4 or more catheterizations daily. Family and patient cooperation was good in 90% of the cases. Patients were managed by IC for a mean period of 4 years (range 1 month-14 years). Only two cases (2%) showed mild, transient complications (urethral pain and cystitis). Normal UUT remained normal in 85%; 45% with compromised UUT improved and 7% became worse. Of the children with no VRR, 94% did not develop this complication; VRR resolved in 72% of the cases (24% by IC alone and 48% with drugs or surgery). Only 12% were continent for more than 3 hours, which increased to 77% (64% by IC alone and 86% with drug therapy or surgery). Urethral sphincter urodynamics was the most important prognostic factor: patients with a lower urethral resistance showed better results for the UUT (p = 0.00373) and VRR (p = 0.00943). The results were also better in patients with normal UUT (p = 0.0003) and no VRR (p = 0.009).

IC is not limited by patient age, sex or sociocultural level. It preserves normal TUS and prevents VRR when instituted early, on demonstrating residual urine and high urethral resistance. IC alone or in combination with other treatments is the basic therapy in NB.