Clean Intermittent Catheterisationcic in Boys with Abnormal Urethra is Problematic at Adolescence

Abstract

Purpose Clean intermittent catheterisation (CIC) is a treatment alternative in boys with bladder dysfunction due to congenital urethral anomalies. Starting CIC has been shown to be easiest during the infant year. In this study boys with abnormal urethra and normal urethral sensitivity treated with CIC has been followed through puberty, and problems with this treatment strategy was evaluated. Material and Methods 22 boys in whom CIC was started early were followed to 14 - 22 years of age. Diagnoses were posterior urethral valves (18), ARM with prostatic fistula (2), prune belly syndrome (1) and ectopic ureterocele (1). CIC was started at median age of 0.7 years (range 0.3-6.6). Results 5/22 boys ended CIC at median age 5 years (range 3-7) because of normalisation of bladder function. 13/22 boys ended CIC at median age 14 years (range 12-16) because of difficulties to introduce the catheter in combination with painful catheterisations. 3 boys developed strictures of the bulbar urethra. Internal urethrotomy was primarily done, but in 2 boys open resection was necessary. At present 3 of the 13 boys with urethral problems catheterise via a Mitrofanoff stoma, 3 have resumed CIC and 7 boys are without CIC despite of need. 4/22 boys are still on CIC without major problems. Conclusion CIC is feasible in boys with abnormal urethras and normal urethral sensitivity through childhood. When reaching puberty catheterisation problems are common and acquired strictures were seen. A catheterisable stoma at an early age should be an option, which could be used both for emptying during day and for night drainage of the bladder.