The role of clean intermittent catheterization(CIC) in the treatment of neurogenic bladder

Abstract

Objective To evaluate the role of clean intermittent catheterization (CIC) in the management of neurogenic bladder in children, Methods Sixty-four children with tethered cord syndrome, who had been undergone spinal cord lysis, were recruited in this study. Among them, 49 were males and 15 were females, aged from 3 to 13 years old.The patients presented with a common symptom of urinary incontinence. Besides this, 60 patients presented with fecal incontinence, and 52 with orthopedic foot deformities. The patients were underwent urodynamic, voiding cystourathrography and ultrasonography immediately and 1 year after diagnosis, respectively. Sixty-four patients were divided into 2 groups: CIC group included 36 children who have performed CIC 5-6 times daily for 1 year, and NO-CIC group included the other 28 children who haven't kept on CIC. Results In CIC group, there were 9 children who had grade 1 through 3 VUR(vesicoureteral reflux) and 4 children who had hydronephrosis. Bladder volume, compliance and detrusor pressure were (176±34. 5) ml, (3. 5 ±0. 6) ml/cmH2O, (54. 6±13. 2) cmH, 2O respectively. One year later after CIC treatment, VUR disappeared in 3 children and hydronephrosis alleviated in 2 children. Bladder volume, compliance and detrusor pressure were (188±30. 3) ml, (3. 7± 0. 9)ml/cmH2O, (50. 6±11.8) cmH2O, respectively. Four children had urinary tract infection (11.1.%). In NO-CIC group, there were 7 children who had grade 1 through 3 VUR and 5 children who had hydronephrosis. Bladder volume, compliance and detrusor pressure were (168±37. 2) ml, (3. 2 ±0.7) ml/cmH2O, (59. 6± 15.6) cmH2O respectively. (One year later, VUR occurred in 13 children and hydronephrosis in 9 children. Bladder volume, compliance and detrusor pressure were (142±23. 6) ml, (1.6±0.7)ml/cmH2O, (72. 4± 9. 3) cmH2O, respectively. Three children had urinary infection(10. 7%). Conclusions CIC can protect bladder and upper urinary tract function without increasing morbidity of urinary tract infection. It plays an important role in the treatment of neurogenic bladder. Key words: Bladder,neurogenic; Tethered cord syndrome