Application Of Early Clean Intermittent Catheterization For Neurogenic Bladder In Children

BackgroundNeurogenic bladder?NB?is a dysfunction of bladder and urethra caused by lesion or damage of the nervous system which results in various symptoms of voiding,such as dysuria and incontinence.NB is a common pediatric urological disease and the most common etiology of NB is nerve damage caused by myelodysplasia.Cerebral palsy,meningitis and pelvic surgery which injure the nerve of controlling bladder and urethra can also lead to NB.If the patients are not treated actively,there will be vesicoureteral reflux?VUR?,hydronephrosis and other upper urinary tract damage which will eventually cause renal failure and endanger the life of children.The treatment of NB is still not unified and simple.But no matter what kind of treatment,treatment principle of NB is to reduce bladder pressure during storage and urination,reduce damage factors of upper urinary tract,prevent or delay the damage of renal function,improve the life quality of patients,protect the life safety of patients.At present,International Continence Society?ICS?recommends clean intermittent catheterization?CIC?as the first choice to empty bladder.It has been widely used in clinical practice.CIC can keep the low pressure of bladder by emptying bladder regularly,prevent VUR and protect the upper urinary tract.However,it is still controversial whether to begin early CIC when infants were clearly diagnosed with NB.ObjectiveTo investigate the effect of early CIC on preserving bladder and upper urinary tract function and provide a reference for the rational selection of CIC beginning time in children with NB.MethodsEighty-four infants with NB diagnosed in urodynamic center of our hospital were less than 1 year old when they first came to hospital from July 2006 to January2012 were retrospectively analyzed,and CIC was carried out at different age.Eighty-four patients were divided into early CIC group?children who were 1ess than1 year old?and late CIC group?children who were more than 3 years old?according to CIC initiation.Among early CIC group patients aged 4-11 months?22 boys and 16girls with a mean age of 8.40±1.73 months?,12 patients suffered from postoperative spina bifida manifesta,22 patients had spina bifida occulta,2 patients had sacral dysplasia,1 patient had undergone intraspinal tumor surgery and 1 patient had meningitis.The late CIC group included 46 patients aged 5-11 months?25 boys and21 girls with a mean age of 8.57±1.57 months?;11 patients were suffering from postoperative spina bifida manifesta,28 patients had spina bifida occulta,5 patients had sacral dysplasia,and 2 patient had undergone pelvic surgery.There were no significant differences of the bladder compliance?BC?,the safe bladder capacity?SBC?and the maximum cystometric capacity?MCC?between two groups when they were diagnosed.Urodynamic parameters and complications of 84 patients who were diagnosed after 3 and 6 years were compared.ResultsAfter 3 years,the BC,SBC and MCC in early CIC group[?7.78±2.59?ml/cmH₂O,?134.74±19.42?ml,?140.26±13.13?ml]were significantly higher than those of late CIC group[?6.63±2.62?ml/cmH₂O,?117.83±15.53?ml,?124.80±11.78?ml;all P<0.05].The rate of VUR[13.16%?5/38?]in the early CIC group was significantly less than that in late CIC group[34.78%?16/46?]?P<0.05?.Hydronephrosis was observed in 3patients?7.89%?in the early CIC group and 12 patients?26.09%?in the late CIC group,which showed significant difference between two groups?P<0.05?.6 patients?15.79%?in the early CIC group and 7 patients?15.22%?in the late CIC group had urinary tract infection?UTI?,which showed no significant difference between two groups?P>0.05?.After 6 years,the BC,SBC and MCC in early CIC group[?10.21±3.01?ml/cmH₂O,?213.32±24.48?ml,?220.53±15.95?ml]were significantly higher than those of late CIC group[?8.50±2.69?ml/cmH2O,?194.28±29.71?ml,?206.63±17.90?ml;all P<0.05].The rate of VUR[21.05%?8/38?]in the early CIC group was significantly less than that in late CIC group[45.65%?21/46?]?P<0.05?.Hydronephrosis was observed in 6 patients?15.79%?in the early CIC group and 18patients?39.13%?in the late CIC group,resulting in a significant difference between two groups?P<0.05?.9 patients?23.68%?in the early CIC group and 8 patients?17.39%?in the late CIC group had UTI,which showed no significant difference between two groups?P>0.05?.ConclusionChildren with NB who are eligible for CIC should carry out early CIC,which is better for improving urodynamic parameters,preventing the incidence of upper urinary tract complications and not increasing the incidence of UTI.