Clean Intermittent Catheterization (CIC) in Children Through Continent Catheterizable Channel: A Developing Country Experience

Abstract

Purpose To evaluate the role of CISC through continent cathetrizable channel (mitrofanoff) in an augmented bladder in children with bladder dysfunction/outlet obstruction managed in a public sector hospital of a developing country. Material and Methods This is a retrospective analysis of 126 patients managed between 2001 and 2008. Patients belong to urban, periurban and rural areas of various part of whole country with diverse ethnic, cultural, linguistic, poor socioeconomic and low educational backgrounds. Results We present our data of 126 patients, age ranged between 21/2 to 15 years, male female ratio of 1.5:1.0, with various congenital and acquired causes of bladder dysfunction/ outlet obstruction including Neurogenic bladder, Non Neurogenic Neurogenic bladder, Posterior Urethral Valve, Exstrophy Epispadias complex, traumatic stricture urethra and Genitourinary Tuberculosis. These patients had augmentation cystoplasty using different bowel segments. The continent catheterizable channel “mitrofanoff channel” was made using appendix in 108 cases while in 18 “spiral Montii” method was used. A stoma was created by VQZ technique in 116 patients while concealed umbilical stoma was made in 10. Complications included superficial wound infection in 9 patients, subacute intestinal obstruction in 6 patients which was resolved by conservative treatment, acute intestinal obstruction, bladder calculus and stomal stenosis in 6, 10 and 3 patients respectively. More than 90% patients showed good compliance and are under regular follow up as per advice of treating team. Conclusions In a developing country setting with low socioeconomic and educational level it is possible to successfully perform augmentation cystoplasty with clean intermittent self catheterization through a continent catheterizable channel in children with bladder dysfunction and outlet obstruction. The active role of paediatric urologists in the care, teaching and counseling together with free care to all are the reasons for acceptance and compliance. To evaluate the role of CISC through continent cathetrizable channel (mitrofanoff) in an augmented bladder in children with bladder dysfunction/outlet obstruction managed in a public sector hospital of a developing country. This is a retrospective analysis of 126 patients managed between 2001 and 2008. Patients belong to urban, periurban and rural areas of various part of whole country with diverse ethnic, cultural, linguistic, poor socioeconomic and low educational backgrounds. We present our data of 126 patients, age ranged between 21/2 to 15 years, male female ratio of 1.5:1.0, with various congenital and acquired causes of bladder dysfunction/ outlet obstruction including Neurogenic bladder, Non Neurogenic Neurogenic bladder, Posterior Urethral Valve, Exstrophy Epispadias complex, traumatic stricture urethra and Genitourinary Tuberculosis. These patients had augmentation cystoplasty using different bowel segments. The continent catheterizable channel “mitrofanoff channel” was made using appendix in 108 cases while in 18 “spiral Montii” method was used. A stoma was created by VQZ technique in 116 patients while concealed umbilical stoma was made in 10. Complications included superficial wound infection in 9 patients, subacute intestinal obstruction in 6 patients which was resolved by conservative treatment, acute intestinal obstruction, bladder calculus and stomal stenosis in 6, 10 and 3 patients respectively. More than 90% patients showed good compliance and are under regular follow up as per advice of treating team. In a developing country setting with low socioeconomic and educational level it is possible to successfully perform augmentation cystoplasty with clean intermittent self catheterization through a continent catheterizable channel in children with bladder dysfunction and outlet obstruction. The active role of paediatric urologists in the care, teaching and counseling together with free care to all are the reasons for acceptance and compliance.