Early application of clean intermittent catheterization in children with neurogenic bladder / 中华泌尿外科杂志

ABSTRACT

Objective To investigate the effect of early application of clean intermittent catheterization(CIC) in infants with neurogenic bladder(NB).Methods Eighty-seven children with NB diagnosed in our urodynamic center were less than 1 year old when they first came to hospital from January 2007 to January 2010, and CIC was carried out at different age.Sixty-four patients were followed up for a long time and divided into early CIC group(less than 1 year old children) and late CIC group(more than 3 years old children) according to the treatment time.Early CIC group included 29 patients [19 boys and 10 girls with the mean age of (7.5 ±2.8) months].And 4 cases were suffering from postoperative spina bifida manifesta;22 cases with spina bifida occulta;2 cases with sacral dysplasia;1 case with meningitis.Late CIC group included 35 patients [20 boys and 15 girls with the mean age of (8.0 ±2.9) months].2 cases were suffering from postoperative spina bifida manifesta;28 cases with spina bifida occulta;4 cases with sacral dysplasia;1 case with postoperative pelvic surgery.Before the treatment, there were no significant differences of the bladder compliance (BC), the maximum cystometric capacity (MCC) and the safety bladder capacity (SBC) between two groups.Urodynamic parameters and complications of 64 patients who were successfully followed up for 6 years were compared.Results After 3 years follow up, BC, SBC and MCC in early CIC group [(8.5 ± 1.9) ml/cmH2O, (140 ±25) ml, (142 ±29) ml]were significantly higher than those of late CIC group [(7.0 ± 2.2) ml/cmH2O, (110 ± 31) ml, (120 ± 28) ml;all P ＜ 0.05].After 6 years follow up, BC, SBC and MCC in early CIC group [(12.0 ±2.5) ml/cmH2O, (210 ±26) ml, (230 ±30) ml] were significantly higher than those of late CIC group [(9.3 ± 2.3) ml/cmH2O, (192 ± 31) ml, (205 ± 35) ml;all P ＜ 0.05], and the vesicoureteral reflux rate [24.1％ (7/29)] in early treatment group was significantly less than that in late treatment group [54.3％ (19/35), P ＜ 0.05].Increases in BUN and serum creatinine were found in 6 cases (20.7％) in early CIC group and 17 cases (48.6％) in late CIC group, the difference was significant (P ＜ 0.05).Conclusion For NB patients, the effect of early CIC is better than that of late CIC.