Treatment of neuropathic bladder with clean intermittent catheterization

Abstract

Objective To retrospectively study the treatment of neuropathic bladder with clean intermittent catheterization (CIC). Methods From Jan. 2001 to May. 2006, 57ases were recruited in this research, including 38 males and 19 females, aged from 3mo to 17yr. Thirtyfive of the patients had repetitive urinary tract infection(UTI), and 45 patients had urinary incontinence. Hydronephrosis was evaluated using the Society of Fetal Urology (SFU) grading based on the long-axis sonographic appearance of the renal parenchyma and pelvicalyceal system. Thirty-eight kidneys had SFU grade 3 to 4hydronephrosis, and 39 had 0 to 2. Urodynamic study revealed hypocontractile bladder in 12 cases, hyper-reflexive bladder in 10 cases, sphincter function failure in 10 cases and dyssynergia in 20 cases. Results Thirty-six of the patients had been followed up for a long term. Out of the 36 patients, 27 patients underwent CIC, 5 patients underwent CIC combined with crede maneuver, the other 4 patients just underwent crede maneuver. CIC was performed 2-3 times daily on 2 patients, 4-6 times daily on 25 patients and more than 6 times daily on 5 patients. The volume of expelled urine was 80-400 ml. Thirty-one patients had repetitive UTI before treatment. Mter CIC treatment, 25 had bacteriuria, and only 8 had episode of febrile UTI For urinary incontinence, Likert score was 2. 25 before treatment, and was significantly improved comparing with 4. 04 of post-treatment score. For hydronephrosis, 30 kidneys were degraded as SFU stage 2, and 42 kidneys were SFU stage 3 or 4 before treatment. After CIC treatment, 40 were below stage 2 and 32 were above stage 3. There was significant difference between the two groups. Conclusions CIC is an important modality for neuropathic bladder. It is effective in controlling UTI and improving incontinence. Key words: Neurogenic bladder; Follow-up studies